经导管主动脉瓣置入术后新发左束支传导阻滞危险因素分析及对左心室功能的影响

Risk factors of new left bundle branch block after transcatheter aortic valve implantation and its influence on left ventricular function

目的:探讨经导管主动脉瓣置入术(TAVI)患者新发左束支传导阻滞(new-LBBB)的危险因素及其对左心室功能的影响。方法:回顾性分析郑州大学第一附属医院2019年8月-2020年8月行TAVI的58例重度主动脉瓣狭窄患者资料。根据术后有无持续性new-LBBB,分为new-LBBB组(15例)和对照组(43例)。分析2组患者术前、术中临床资料及术前、术后超声心动图结果的差异。结果:new-LBBB组术前基础QRS波时限、术中置入人工瓣膜尺寸大于对照组,差异均有统计学意义(P<0.05);术后1年new-LBBB组左心室射血分数(LVEF)低于对照组,左心室舒张末期直径(LVEDD)高于对照组,差异均有统计学意义(P<0.05)。结论:基础QRS波时限、人工瓣膜尺寸是TAVI后new-LBBB的独立危险因素;TAVI后new-LBBB可能影响患者的LVEF和左心室结构。

Objective:To investigate the risk factors of new-LBBB in patients undergoing transcatheter aortic valve implantation(TAVI)and its effect on left ventricular function.Methods:The data of 58 patients with severe aortic stenosis who underwent TAVI from August 2019 to August 2020 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.According to postoperative persistence of new-LBBB,they were divided into new-LBBB group(n=15)and control group(n=43).Preoperative and intraoperative clinical data and preoperative and postoperative echocardiography results were analyzed.Results:The preoperative basic QRS duration and intraoperative prosthetic valve size of the new-LBBB group were larger than those of the control group(P<0.05).One year after the operation,the left ventricular ejection fraction(LVEF)in the new LBBB group was lower than that in the control group,and the left ventricular end diastolic diameter(LVEDD)was higher than that in the control group(P<0.05).Conclusion:Basic QRS duration and artificial valve size were independent risk factors for new-LBBB after TAVI;New-LBBB after TAVI may affect LVEF and left ventricular structure in patients.