完全性左束支传导阻滞对缺血性心肌病预后的影响

目的观察伴有完全性左束支传导阻滞对缺血性心肌病患者远期预后的影响。方法选择2004年1月—2009年12月冠状动脉造影检查中经左室造影证实左室射血分数≤35%的缺血性心肌病患者899例,经心电图检查证实存在柬支传导阻滞25例(LBBB组)。选择同期无束支传导阻滞缺血性心肌病患者48例为对照组。通过住院病历记录,门诊随访、再入院复查、电话随访了解患者的预后。结果 LBBB组饮酒史高于对照组(32.0%vs.14.6%,P<0.01),心功能分级Ⅱ^Ⅳ级高于对照组(24.0%vs.10.4%,P<0.01),前壁心肌梗死病史的比例明显高于对照组(88.0%vs.75.0%,P<0.01),心脏超声左房内径和左室舒张末期内径大于对照组患者(41.0±6.9)mm vs.(37.0±3.8)mm,P<0.01;(65.0±5.3)mm vs.(60.0±4.8)mm,P<0.01],前降支合并回旋支病变的比例高于对照组(16.0%vs.8.3%,P<0.01)。LBBB组患者发生全因死亡、血流动力学终点事件的比例亦明显高于对照组患者,差异均有统计学意义(12.0%vs.6.3%、64.0%vs.27.1%,P均<0.01)。Cox回归分析显示:前壁心肌梗死、左柬支传导阻滞是缺血性心肌病发生全因死亡、心力衰竭再入院、室性心律失常、心脏移植复合终点事件的危险因素(RR=1.04、1.13,P<0.01)。结论完全性左束支传导阻滞是左室射血分数≤35%的缺血性心肌病患者预后不良的危险因素,与无束支传导阻滞的缺血性心肌病患者比较,发生全因死亡、心力衰竭再入院、心脏移植的比例明显增加。

Analysis of el ft bundle bra nch block impact on the prognosis of ischemic cardiomyopathy

Objective To observe the long term prognosis effect of complete left bundle branch block （ LBBB） on pa-tients with ischemic cardiomyopathy .Methods From 2004 January to 2009 December , 899 ischemic cardiomyopathy patients with left ventricular angiography confirmed LVEF≤35%were enrolled, the ECG examination confirmed the presence of bun-dle branch block in 25 cases （ group LBBB ） .Select the same period 48 ischemic cardiomyopathy patients without bundle branch block as the control group .Through inpatient medical records , follow-up, re-admission review , telephone follow-up to evaluate the prognosis of the patients .Results Drinking history of group LBBB was higher than the control group （32.0%vs. 14.6%）.In LBBB group, the ratio of patients with anterior wall myocardial infarction history was significantly higher than the control group （88.0%vs.75.0%）, left atrial echocardiographic diameter and left ventricular end diastolic diameter greater than the patients in the control group （41.0 ±6.9） mm vs.（37.0 ±3.8） mm,（65.0 ±5.3） mm vs.（60.0 ±4.8） mm], the proportion of combined lesions in the anterior descending and circumflex branch was higher than the control group （16.0%vs.8.3%）, the differences were statistically significant （ P 〈0.01）.All-cause mortality, hemodynamic endpoints ratio in LBBB group was obviously higher than that in control group , the differences were statistically significant （12.0%vs.6.3%, 64.0%vs.27.1%, P 〈0.01）.Cox regression analysis showed： anterior wall myocardial infarction , left bundle branch block are risk factors of heart failure death , readmission , ventricular arrhythmia , heart transplant composite endpoint in ische-mic cardiomyopathy patients （RR=1.04, RR=1.13, P 〈0.01）.Conclusion Complete left bundle branch block is risk factor of adverse outcomes in ischemic cardiomyopathy patients with LVEF ≤35%, compared with patients without bundle branch block , occurrence of all-cause mortality , heart failure readmission , he