合并左束支阻滞的冠心病患者临床及冠状动脉造影特点分析

目的分析合并完全性左束支阻滞（LBBB）的冠心病患者的临床以及冠状动脉造影特点。方法285例2002年1月至2008年1月收入院心电图显示LBBB的患者，并接受冠状动脉造影检查。年龄33～86（60±9）岁，其中男性165例，女性120例。采用Judkins法进行选择性冠状动脉及左心室造影检查，通过计算机图像处理系统测定左心室射血分数（LVEF）。结果在285例患者中根据造影检查结果，确诊为冠心病者174例，其中男性117例，女性57例。平均年龄（65±9）岁。排除冠心病者111例，其中男性48例，女性63例。平均年龄（60±9）岁，与不合并冠心病者相比，冠心病合并LBBB者，年龄较大，男性多见，糖尿病、高血压、既往心肌梗死发生率较高；冠状动脉造影显示：单支、双支和3支病变分别占32％、20％和46％。病变部位：前降支受累者最多见，占89％，回旋支受累者58％，右冠状动脉占64％，累及左主干者18％。多变量分析结果显示：经冠状动脉造影确诊的合并LBBB的冠心病患者，其独立预测因素包括：男性、年龄增加，合并高血压、糖尿病、既往心肌梗死者与冠心病发生密切相关，危险因素越多，冠状动脉造影诊断的冠心病发生率越高。结论合并LBBB的大多数冠心病患者，其临床特征包括高龄、男性、多合并糖尿病和／或高血压，既往有心肌梗死史。当LBBB伴不明原因胸痛或心电图异常难以解释时，冠状动脉造影有助于确定缺血性心脏病及病因诊断。

Clinical significance and the characteristics of coronary angiography in patients with complete left bundie branch block and concomitant coronary artery disease

Objective To analyses the characteristics of coronary angiography in patients with complete left bundle branch block (LBBB) and concomitant coronary artery disease (CAD). Methods Two hundred and eighty-five patients with LBBB were subjected to coronary angiographic study. The age range was 33 to 86 years old mean (60±9) years]. There were 165 men and 120 women. The diagnosis of LBBB was based upon electrocardiography. Patients underwent selective coronary angiography and left ventriculography by use of the Judkins technique. Statistical analysis was performed using SAS software methods for small samples. Results Of the 285,61% had CAD, compared with the patients without CAD,the patients with CAD were older; more likely to be men; more likely to have previous myocardial infarction, diabetes mellitus and hypertension Coronary angiogram revealed that single vessel disease, double vessels disease and triple vessels disease were 32% ,20% and 46% respectively. LAD lesion was most. In multivariate analysis, independent predictors were male gender, increasing age, diabetes mellitus and hypertension.Conclusion The most subjects with LBBB and concomitant CAD are likely to have certain clinical characteristics. The patients with CAD were older;more likely to be men; more likely to have previous myocardial infarction, diabetes mellitus and hypertension.When left bundle branch block was associated with chest pain of uncertain etiology, or unexplained electrocardiographic abnormality, coronary angiogram was helpful to confirm ischemic heart disease and etiology.