经导管主动脉瓣置换术后新发完全性左束支传导阻滞的影响因素及其对心脏重构逆转的影响

Impact factors of new-onset complete left bundle branch block after transcatheter aortic valve replacement and its effects on cardiac remodeling reversal

目的 分析主动脉瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVR)后新发完全性左束支传导阻滞(CLBBB)的影响因素及CLBBB对术后心脏重构逆转的影响。方法 收集55例接受TAVR治疗的AS患者,其中16例术后新发CLBBB并持续至少1个月(CLBBB组),31例术后未出现新发CLBBB、8例术后1天内出现新发CLBBB但于1个月内CLBBB消失(NO-CLBBB组);对比2组术前与术后1天血红蛋白(Hb)、N-末端脑利钠肽前体(NT-proBNP)、肌酐(Cr)、肌酸激酶同工酶(CK-MB)及肌钙蛋白(cTn),以及术前与术后1个月超声心动图相关参数及NYHA心功能分级。结果 2组术后1天血清cTn均较术前升高(P均<0.05),但组间差异无统计学意义(P>0.05)。术前CLBBB组室间隔舒张末期厚度(IVSD)、主动脉瓣峰值跨瓣压差(PPG)、主动脉瓣平均跨瓣压差(MPG)均大于NO-CLBBB组(P均<0.05)。术后1个月,NO-CLBBB组左心室质量(LVM)、IVSD、左心室后壁舒张末期厚度(LVPWD)、肺动脉收缩压(PASP)、PPG、MPG均较术前降低,主动脉瓣口面积(AVA)较术前增大(P均<0.01);CLBBB组IVSD、PPG、MPG均较术前降低,AVA较术前增大(P均<0.01)。其余各指标组间及组内差异均无统计学意义(P均>0.05)。结论 PPG、MPG及IVSD是TAVR治疗AS后患者新发CLBBB的影响因素;新发CLBBB影响心脏重构逆转。

Objective To analyze the influence factors of new-onset complete left bundle branch block(CLBBB)after transcatheter aortic valve replacement(TAVR)in patients with aortic stenosis(AS),and to explore the impact of CLBBB on postoperative cardiac remodeling reversal.Methods Totally 55 patients with AS who underwent TAVR were enrolled.Among them,new-onset CLBBB after TAVR and lasted for at least 1 month was observed in 16 patients(CLBBB group),while 31 patients did not develop new CLBBB after operation and 8 patients developed new CLBBB within 1 day after operation but CLBBB disappeared within 1 month were included in NO-CLBBB group.The hemoglobin(Hb),N-terminal pro-brain natriuretic peptide(NT-proBNP),creatinine(Cr),creatine kinase-MB(CK-MB)and troponin(cTn)before and 1 day after TAVR were compared between groups.Echocardiographic parameters,as well as NYHA cardiac function classification before and 1 month after TAVR were also compared between groups.Results Serum cTn at 1 day after TAVR was significantly higher than that before in both groups(both P<0.05),and there was no significant difference between groups(both P>0.05).The interventricular septum thickness at end-diastole(IVSD),aortic valve peak pressure gradient(PPG)and aortic valve mean pressure gradient(MPG)of CLBBB group were significantly higher than those of NO-CLBBB group before TAVR(all P<0.05).In NO-CLBBB group,1 month after TAVR,the left ventricular mass(LVM),IVSD,left ventricular posterior wall thickness at end-diastole(LVPWD),pulmonary artery systolic pressure(PASP),PPG and MPG decreased,while aortic valve orifice area(AVA)increased compared with those before operation(all P<0.01).In CLBBB group,IVSd,PPG and MPG decreased 1 month after TAVR,while AVA increased compared with those before operation(all P<0.01).There was no significant difference of the other indexes between and within groups(all P>0.05).Conclusion After TAVR for treating AS,PPG,MPG and IVSD were impact factors of new CLBBB.New-onset CLBBB affected postoperative cardiac remodeling reversal.