Bouzas-Mosquera Alberto, Peteiro Jesús, Alvarez-García Nemesio, Broullón Francisco J, García-Bueno Lourdes, Ferro Luis, Pérez Ruth, Bouzas Beatriz, Fábregas Ramón, Castro-Beiras Alfonso
Department of Cardiology, Hospital Universitario A Coruña, As Xubias, A Coruña, Spain.
JACC Cardiovasc Imaging. 2009 Mar;2(3):251-9. doi: 10.1016/j.jcmg.2008.11.014.
Our aim was to evaluate the role of exercise echocardiography for predicting outcome in a cohort of patients with left bundle branch block (LBBB).
Although the prognostic value of exercise echocardiography has been well established in several subgroups of patients, it has not been specifically assessed in patients with LBBB.
Of the 8,050 patients who underwent treadmill exercise echocardiography, 618 demonstrated complete LBBB. Nine patients were lost to follow-up and 609 patients were included in this study. Wall motion score index (WMSI) was evaluated at rest and at peak exercise, and the difference (DeltaWMSI) was calculated. Ischemia was defined as the development of new or worsening wall motion abnormalities with exercise. End points were all-cause mortality and major cardiac events (including cardiac death, myocardial infarction, or cardiac transplantation). Mean follow-up was 4.6 +/- 3.4 years.
Mean age was 66 +/- 10 years, and 331 patients (54%) were men. A total of 177 patients (29%) developed ischemia with exercise. During follow-up, 124 deaths occurred, and 74 patients had a major cardiac event before any revascularization procedure. Patients with ischemia had a greater 5-year mortality rate (24.6% vs. 12.6%, p < 0.001) and 5-year major cardiac events rate (18.1% vs. 9.7%, p = 0.003). In multivariate analysis, DeltaWMSI remained an independent predictor of mortality (hazard ratio: 2.42, 95% confidence interval: 1.21 to 4.82, p = 0.012) and major cardiac events (hazard ratio: 3.38, 95% confidence interval: 1.30 to 8.82, p = 0.013). Exercise echocardiographic results also provided incremental value over clinical, resting echocardiographic, and treadmill exercise data for the prediction of mortality (p = 0.014) and major cardiac events (p = 0.017).
Exercise echocardiography provides significant prognostic information for predicting outcome in patients with LBBB. As compared to patients with normal exercise echocardiograms, patients with abnormal results are at increased risk of mortality and major cardiac events.
我们的目的是评估运动超声心动图在预测左束支传导阻滞（LBBB）患者队列预后中的作用。
尽管运动超声心动图的预后价值在几个患者亚组中已得到充分证实，但尚未在LBBB患者中进行专门评估。
在8050例行平板运动超声心动图检查的患者中，618例表现为完全性LBBB。9例患者失访，609例患者纳入本研究。在静息和运动高峰时评估壁运动评分指数（WMSI），并计算差值（ΔWMSI）。缺血定义为运动时出现新的或加重的壁运动异常。终点为全因死亡率和主要心脏事件（包括心源性死亡、心肌梗死或心脏移植）。平均随访时间为4.6±3.4年。
平均年龄为66±10岁，331例患者（54%）为男性。共有177例患者（29%）运动时出现缺血。随访期间，发生124例死亡，74例患者在任何血运重建手术前发生主要心脏事件。缺血患者的5年死亡率（24.6%对12.6%，p<0.001）和5年主要心脏事件发生率（18.1%对9.7%，p=0.003）更高。在多变量分析中，ΔWMSI仍然是死亡率（风险比：2.42，95%置信区间：1.21至4.82，p=0.012）和主要心脏事件（风险比：3.38，95%置信区间：1.30至8.82，p=0.013）的独立预测因素。运动超声心动图结果在预测死亡率（p=0.014）和主要心脏事件（p=0.017）方面也比临床、静息超声心动图和平板运动数据提供了更多价值。
运动超声心动图为预测LBBB患者的预后提供了重要的预后信息。与运动超声心动图正常的患者相比，结果异常的患者死亡和发生主要心脏事件的风险增加。
