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左心室收缩不同步在非缺血性扩张型心肌病患者的预后价值

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第2期
页码:
204-207
栏目:
临床研究
出版日期:
2013-04-25

文章信息/Info

Title:
Prognostic significance of left ventricular systolic dyssynchrony in patients with nonischemic dilated cardiomyopathy
作者:
刘忠芬1; 刘怡红1; 杜宗雷2; 王玉其2; 孙晓斐3
(1.章丘市人民医院急症科，山东 章丘 250200；2.邹城市人民医院心内科，山东 邹城 273500；3.济宁市第一人民医院心脏中心，山东 济宁 272000)
Author(s):
LIU Zhong-fen1;  LIU Yi-hong1;  DU Zong-lei2;  WANG Yu-qi2;  SUN Xiao-fei3
(1.Department of Emergency, People's Hospital of Zhangqiu City, Zhangqiu 250200, Shandong, China; 2.Department of Cardiology, Zoucheng People’s Hospital, Zoucheng 273500, Shandong, China; 3.Center of Cardiology, Jining First People's Hospital, Jining 272000, Shandong, China)
关键词:
心肌病; 扩张型; 非缺血性; 左心室收缩不同步; 超声心动图; 心电描记术; 预后
Keywords:
nonischemic dilated cardiomyopathy;  ventricular systolic dyssynchrony;  echocardiography;  electrocardiography;  prognosis
分类号:
R542.2
DOI:
-
文献标识码:
A
摘要:
目的:运用组织多普勒超声心动图研究左心室收缩不同步在非缺血性扩张型心肌病患者中的预后价值。方法： 入选62例非缺血性扩张型心肌病患者，所有患者均行心电图、超声心动图（包括组织多普勒超声心动图）及冠状动脉造影，入选患者根据心室内延迟时间（IVD）分为2组：IVD≤65 ms组(n=10）和IVD>65 ms组(n=52）,主要终点定义为随访期内的全因死亡。结果： IVD>65 ms组患者有较长的心室内延迟时间［(129±68) ms vs.(58±9) ms；P<0.05］,较高的左束支传导阻滞发生率(31% vs. 10%;P=0.05),更长的QRS间期［(145±29) ms vs.(129±23) ms，P<0.05］较高的病死率(56% vs. 10%;P<0.01). IVD≤65 ms组中1例患者发生心源性猝死；而IVD>65 ms组中有12例发生，且其他原因引起的死亡也发生在组IVD>65 ms组。Kaplan-Meier生存分析显示IVD>65 ms组患者有较低的生存率(P<0.05)，多因素分析显示IVD是唯一具有显著差异的死亡预测因子(P<0.01)。结论： 高IVD是非缺血性扩张型心肌病患者死亡的独立预测因素。
Abstract:
AIM:To investigate the prognostic significance of left ventricular (LV) systolic dyssynchrony in nonischemic dilated cardiomyopathy (DCM) using tissue Doppler echocardiography (TDI). METHODS: The study was conducted in 62 patients with nonischemic DCM. All patients were examined by electrocardiography TDI and angiography. Patients were allocated into two groups: group 1-10 patients with intraventricular delay (IVD)≤65 msec and group 2-52 patients with IVD >65 msec. The primary endpoint was defined as overall mortality during a mean follow-up period. RESULTS: Patients in group 2 had significantly longer mean IVD ［(129±68) msec vs. (58±9) msec; P<0.05］, higher rate of left bundle branch block (31% vs. 10%; P=0.05), longer QRS duration ［(145±29) msec vs. (129±23) msec; P<0.05］ and higher fatality rate (56% vs. 10%; P<0.01). Sudden cardiac death occurred in one patient in group 1 but in 12 patients in group 2. All the remaining deaths (n=17) occurred in group 2. Kaplan-Meier survival analysis showed a significantly lower survival in group 2 (P<0.05) and multivariate analysis showed that IVD was the only significant independent predictor of mortality (P<0.01). CONCLUSION: Increased IVD is associated with increased risk for death in patients with nonischemic DCM, independent of the QRS width and LV ejection fraction.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2012-04-08.通讯作者：杜宗雷，主治医师，主要从事冠心病的研究Email：duzonglei001@sina.com 作者简介：刘忠芬，主治医师，硕士 Email：qiufen1969@yeah.net 作者简介：刘晓琳，硕士生 Email：275751158@qq.com
更新日期/Last Update: 2013-04-28