心力衰竭伴不同宽度左束支传导阻滞患者对心脏再同步治疗反应的分析

Analysis of reaction to resynchronization therapy in heart failure patients with left bundle branch block in different QRS width

目的：分析左束支传导阻滞（left bundle branch block,LBBB）心力衰竭患者对心脏再同步（cardiac resynchronization therapy,CRT）治疗的疗效反应情况.方法：回顾性分析在本院成功置入CRT伴LBBB的心力衰竭患者.所有患者术前、术后1w及最终随访均行12导联心电图、超声心动图、组织多普勒.均对比术前、术后左心室大小、射血分数及生存现状.结果：共44例完成随访,随访6 ～61个月,平均27.12个月,4例再同步治疗后仍反复出现心力衰竭并因此再入院治疗,无死亡病例.共有38例（86.4％）患者对CRT治疗有反应,真性LBBB亚组中29例（93.5％）有反应,非真性LBBB亚组中9例（69.2％）有反应.真性LBBB亚组左心室射血分数绝对值、左心室舒张末径（left ventricular end dias-tolic diameter,LVEDD）及左心室射血分数的改善程度更显著,差异有统计学意义.结论：CRT治疗可使大部分患者获益,真性LBBB患者心功能改善更为显著,但终末期心脏失代偿严重者难于从中获益.

Objective ： The aim of the study was to evaluate the response to CRT among 44 LBBB Heart failure patients. Methods： Retrospective analysis of the hospital successfully implanted CRT in patients with left bundle branch block （LBBB） and heart failure. All patients underwent 12 lead electrocardiogram, echocardiography, tissue Doppler, as well as 1 week after operation and the final follow-up review. Results： A total of 44 patients completed a follow-up, follow-up of（ 27.12 ＋ 18.61 ） months, there are 38 responders （ 86. 36% ） in total, 29 responders（93.54% ）in true LBBB subgroup and 9（69.23% ）in non-true LBBB. When the final fol- low-up, The true LBBB subgroup showed significant improvement in LVEF, and the improvement of LVEDD, LVEF showed more obviously with statistical difference. Conclusion： CRT therapy is good to most heart failure patients. The improvement of heart function in true LBBB patients is more significant. But end-stage cardiac decompensate patients are serious difficult to benefit from CRT therapy.