冠状动脉慢性完全闭塞病变QRS波时限与血运重建术后左心功能改善的关系

Relationship Between QRS Complex Duration and Left Ventricular Function Recovery after Coronary Revascularization in Patients with Chronic Total Occlusion

探讨冠状动脉慢性完全闭塞(CTO)的患者QRS波时限与经皮冠状动脉介入治疗(PCI)后左心功能改善的关系。回顾性分析2015年8月~2016年8月在笔者所在医院行PCI至少有一支主要冠脉完全闭塞的患者192例。据术前体表心电图QRS波群,将时限≥110ms患者分为观察组(70例),时限<110ms的患者分为对照组(122例)。随访12个月,记录相关观察指标。结果经术前与术后12个月对比,两组患者PCI后相关指标:左心室射血分数(LVEF)、血浆N-proBNP浓度、NYHA心功能分级均有所改善。与术前相比,对照组术后LVEF[(59.00±8.69)%比(50.78±8.44)%,P=0.03]增加、血浆N-proBNP浓度[(542.89±135.24)pg/ml比(734.65±198.30)pg/ml,P=0.04]减少、NYHA心功能分级改善(P=0.02),差异有统计学意义。而观察组差异无统计学意义(P>0.05)。因此,QRS波时限正常范围的患者较QRS波时限延长的患者左心功能改善明显,通过分析体表心电图QRS波时限能够预测患者血运重建术后左心功能的改善情况。

To explore the relationship between QRS complex duration and left ventricular function recovery after percutaneous coronary intervention( PCI) in patients with chronic total occlusion. Patients( n = 192) with chronic total occlusion( at least one major coronary occlusion) underwent successful intervention from August 2015 to August 2016 were included and divided into control group( n = 70) and observation group( n = 122) based on the QRS complex duration on ECG before PCI. At baseline and12 months after PCI,cardiac function was recorded. 12 months after PCI,indicators showed increase in left ventricular ejection fraction( LVEF) with decrease in the level of N-proBNP and improvement in patients' NYHA classification were observed in both groups. Compared with control group,observation group had more significant increase of LVEF [( 59.00±8.69) % vs.( 50.78±88.44) %,P = 0.03],more significant decrease of the level of N-proBNP [( 542.89±135.24) pg/ml vs.( 734.65±198.30) pg/ml,P= 0.04] and more significant improvement in NYHA classification( P = 0.02). Therefore,PCI can improve the cardiac function in the patients with CTO,and the improvement of left ventricular function is more obvious in patients with normal QRS complex duration after PCI. QRS complex can predict the recovery of regional wall motion in patients with successful CTO recanalization.