Cortigiani Lauro, Bigi Riccardo, Gigli Guido, Coletta Claudio, Mariotti Egidio, Dodi Claudio, Astarita Costantino, Picano Eugenio
Division of Cardiology, Lucca Hospital, Lucca, Italy.
Am J Med. 2003 Jul;115(1):12-8. doi: 10.1016/s0002-9343(03)00239-0.
To investigate the prognostic implications of conduction defects in subjects without proven coronary artery disease who had been referred for stress echocardiography.
The study sample consisted of 1230 patients (574 men and 656 women; mean [+/- SD] age, 63 +/- 10 years) who underwent stress echocardiography with dipyridamole (n = 780) or dobutamine (n = 450) to evaluate suspected coronary artery disease. A summary wall motion score (on a 1 to 4 scale) was calculated. Patients were followed for a mean of 41 +/- 27 months; mortality was the only endpoint.
Four hundred and twenty patients (34%) had intraventricular conduction defects on a resting electrocardiogram (173 with complete left bundle branch block, 98 with isolated right bundle branch block, 43 with right bundle branch block with left anterior hemiblock, and 106 with left anterior hemiblock). Ischemia at stress echo (new or worsening of preexisting wall motion abnormality) was found in 250 patients (20%). There were 56 deaths during follow-up; 138 patients underwent revascularization and were censored. Multivariate predictors of mortality were resting wall motion score index (hazard ratio [HR] = 6.0 per unit increase; 95% confidence interval [CI]: 2.3 to 16; P <0.0001), ischemia at stress echo (HR = 3.9; 95% CI: 2.2 to 6.7; P <0.0001), age >65 years (HR = 3.2; 95% CI: 1.7 to 5.9; P <0.0001), hypertension (HR = 1.8; 95% CI: 1.1 to 3.2; P = 0.03), and right bundle branch block with left anterior hemiblock (HR = 3.7; 95% CI: 1.8 to 7.5; P <0.0001). The other three forms of intraventricular conduction defects (left bundle branch block, isolated complete right bundle branch block, and left anterior hemiblock) were not associated with mortality in multivariate analyses, or among the 980 patients who did not have ischemia.
Right bundle branch block with left anterior hemiblock is an independent predictor of mortality in patients with suspected coronary artery disease undergoing stress echocardiography, whereas isolated right bundle branch block is associated with outcomes similar to those observed in patients with no conduction defects.
研究在因负荷超声心动图检查而就诊的无确诊冠心病患者中，传导缺陷的预后意义。
研究样本包括1230例患者（574例男性和656例女性；平均[±标准差]年龄为63±10岁），这些患者接受了双嘧达莫（n = 780）或多巴酚丁胺（n = 450）负荷超声心动图检查以评估疑似冠心病。计算了一个汇总的室壁运动评分（范围为1至4分）。患者平均随访41±27个月；死亡率是唯一的终点。
420例患者（34%）静息心电图存在室内传导缺陷（173例完全性左束支传导阻滞，98例孤立性右束支传导阻滞，43例右束支传导阻滞合并左前分支阻滞，106例左前分支阻滞）。负荷超声心动图检查发现缺血（新出现或原有室壁运动异常加重）的患者有250例（20%）。随访期间有56例死亡；138例患者接受了血运重建并被剔除。死亡率的多因素预测指标包括静息室壁运动评分指数（风险比[HR]=每增加一个单位为6.0；95%置信区间[CI]：2.
