不同病因左心室肥厚间歇性完全性左束支传导阻滞发生情况和心率变异性指标分析

Analysis on Occurrence and Heart Rate Variability Indexes of Left Ventricular Hypertrophic Intermittent Complete Left Bundle Branch Block of Different Etiologies

目的探讨不同病因左心室肥厚间歇性完全性左束支传导阻滞(LBBB)发生情况和心率变异性(HRV)指标的差异。方法选择2018年8月至2020年8月河北北方学院第一附属医院心脏功能检查科收治的200例左心室肥厚患者为研究对象,依据24 h动态血压监测数据及患者病史、心脏超声、十二导联常规心电图、冠状动脉造影结果分为肥厚性心肌病左心室肥厚组(26例)、主动脉瓣狭窄左心室肥厚组(30例)、冠心病左心室肥厚组(64例)及高血压左心室肥厚组(80例),记录患者的24 h动态心电图,比较四组患者间歇性LBBB发生率及HRV指标的差异。结果肥厚性心肌病左心室肥厚组间歇性完全性LBBB发生率为7.69%(2/26),主动脉瓣狭窄左心室肥厚组为6.67%(2/30),冠心病左心室肥厚组为28.12%(18/64),高血压左心室肥厚组为30.00%(24/80),其中冠心病左心室肥厚组、高血压左心室肥厚组间歇性完全性LBBB发生率高于肥厚性心肌病左心室肥厚组和主动脉狭窄左心室肥厚组(P<0.05)。各组HRV时域指标SDNN比较差异有统计学意义(P<0.01),高血压左心室肥厚组高于肥厚性心肌病左心室肥厚组、主动脉狭窄左心室肥厚组、冠心病左心室肥厚组(P<0.05);各组HRV频域指标极低频功率、高频功率比较差异均无统计学意义(P>0.05)。结论高血压左心室肥厚及冠心病左心室肥厚患者间歇性LBBB发生率偏高,高血压左心室肥厚患者心率变异性时域指标高于其余病因所致左心室肥厚患者。

Objective To investigate the incidence of intermittent complete left bundle branch block(LBBB)and the heart rate variability(HRV)indexes in patients with left ventricular hypertrophy of different etiologies.Methods A total of 200 patients who visited ECG Department of the First Affiliated Hospital of Hebei North University from Aug.2018 to Aug.2020 were included,according to the 24 h ambulatory blood pressure monitoring data and the patient′s medical history and cardiac ultrasound results,12 leads conventional ECG and coronary angiography,the patients were divided into a hypertrophic cardiomyopathy left ventricular hypertrophy group(26 cases),an aortic stenosis left ventricular hypertrophy group(30 cases),a coronary heart disease left ventricular hypertrophy group(64 cases)and a hypertensive left ventricular hypertrophy group(80 cases).The 24 h Holter was recorded to compare the incidence of intermittent complete LBBB and HRV in the four groups.Results The incidence of intermittent complete LBBB in the hypertrophic cardiomyopathy group was 7.69%(2/26),in the aortic stenosis group was 6.67%(2/30),in the coronary heart disease group was 28.12%(18/64),and in the hypertensive group was 30.00%(24/80).The incidence of intermittent complete LBBB in the coronary heart disease group and hypertension group were higher than those of the hypertrophic cardiomyopathy group and aortic stenosis group(P<0.05).There was significant difference in SDNN of HRV time domain index among the groups(P<0.01),and the hypertensive group was higher than the hypertrophic cardiomyopathy group,the aortic stenosis group and the coronary heart disease group(P<0.05);there was no significant difference in extremely low frequency power and high frequency power of HRV frequency domain index among the groups(P>0.05).Conclusion The incidence of intermittent LBBB is higher in patients with hypertensive left ventricular hypertrophy and coronary heart disease left ventricular hypertrophy.The time domain index of HRV in the patients with hypertensive left ventricular hypertrophy is higher than that in the patients with other causes of left ventricular hypertrophy.