真性完全性左束支阻滞心电图特征与心力衰竭患者心脏再同步化疗效的观察

Observation on the characteristics of left bundle branch block electrocardiogram and the effect of cardiac resynchronization in patients with heart failure

目的比较真性完全性左束支阻滞(CLBBB)心电图特征与心力衰竭患者行心脏再同步化治疗(CRT)效果的关系。方法连续选择76例诊断为慢性稳定型心力衰竭患者,符合CRT的植入指征,其中具备真性CLBBB诊断标准患者33例(观察组)和传统CLBBB诊断标准43例(对照组),随访比较治疗效果。结果术后1个月、6个月和12个月两组的QRS波时限、左室舒张末期内径、氨基末端脑钠肽前体和平均心率(次/分)均逐渐降低,左室射血分数逐渐增加(P均<0.05);且各时间点观察组的上述指标较对照组改善程度增加,QRS波时限(ms)(术后1个月128.5±4.2 vs 134.7±4.0、6个月124.9±3.6 vs 131.5±3.7、12个月120.8±3.0 vs 127.5±3.2),左室舒张末期内径(mm)(术后1个月53.6±2.6 vs 54.7±2.5、6个月50.5±2.3 vs 52.9±2.4、12个月47.8±2.1 vs 51.7±2.8),氨基末端脑钠肽前体,平均心率,左室射血分数(术后1个月0.43±0.04 vs 0.40±0.03、6个月0.47±0.04 vs 0.43±0.03、12个月0.50±0.04 vs 0.46±0.04),差异均有显著性(P均<0.05);观察组的主要心脏不良事件发生率和心力衰竭加重发生率明显降低(15.2% vs 37.2%和6.1% vs 23.3%,P均<0.05)。结论真性完全性左束支阻滞的心电图特征可能是增加CRT治疗效果的重要指标。

Objective To compare the relationship between the ECG characteristics of true complete left bundle branch block(CLBBB)and the effect of cardiac resynchronization therapy(CRT)in patients with heart failure. Methods Seventy-six patients diagnosed with chronic stable heart failure were successively selected,consistent with the implantation indications of CRT.Among them,33 patients with true CLBBB diagnostic criteria(observation group)and 43 patients with traditional CLBBB diagnostic criteria(control group)were followed up to compare the therapeutic effect. Results 1,6 and 12 months after surgery,QRS wave duration,left ventricular end-diastolic diameter,pro-BNP average heart rate all went down in two groups,and left ventricular ejection fraction gradually increased(all P<0.05).In addition,the above indexes of the observation group at each time point increased compared with the control group,QRS wave duration(ms)(1 months after surgery 128.5±4.2 vs 134.7±4.0,6 months 124.9±3.6 vs 131.5±3.7,12 months 120.8±3.0 vs 127.5±3.2),left ventricular end-diastolic diameter(mm)(1 months after surgery 53.6±2.6 vs 54.7±2.5,6 months 50.5±2.3 vs 52.9±2.4,12 months 47.8±2.1 vs 51.7±2.8),pro-BNP,average heart rate and LVEF(1 months after surgery 0.43±0.04 vs 0.40±0.03,6 months 0.47±0.04 vs 0.43±0.03,12 months 0.50±0.04 vs 0.46±0.04)(all P<0.05).The incidence of major cardiac adverse events and aggravation of heart failure in the observation group were significantly decreased,with significant differences(15.2% vs 37.2% and 6.1% vs 23.3%,P<0.05). Conclusion The electrocardiogram characteristics of true and CLBBB may be an important index to increase the therapeutic effect of CRT.