左心室功能障碍患者的左心室传导延迟及其与QRS波形态的关系。
Left ventricular conduction delays and relation to QRS configuration in patients with left ventricular dysfunction.
作者信息
Varma Niraj
机构信息
Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
Am J Cardiol. 2009 Jun 1;103(11):1578-85. doi: 10.1016/j.amjcard.2009.01.379. Epub 2009 Apr 22.
Left ventricular activation delay (LVAT) >100 ms may determine response to cardiac resynchronization therapy, but its prevalence and relation to QRS configuration are unknown. QRS duration and LVAT in control subjects (n = 30) were compared with those in patients with heart failure (HF; LV ejection fraction 23 +/- 8%, n = 120) with a QRS duration <120 ms (NQRS(HF), n = 35) or > or = 120 ms (left bundle branch block [LBBB(HF)], n = 54; right bundle branch block [RBBB(HF)], n = 31). LVAT was estimated by interval from QRS onset to basal inferolateral LV depolarization. In controls, QRS duration was 82 +/- 13 ms and LVAT was 55 +/- 18 ms. LVAT was always <100 ms. In patients with NQRS(HF), QRS duration (104 +/- 10 ms) and LVAT (82 +/- 22 ms) were prolonged versus controls (p <0.001). LVAT exceeded 100 ms in 8 of 35 patients. In patients with LBBB(HF), QRS duration (161 +/- 29 ms) and LVAT (136 +/- 33 ms) were prolonged compared with controls and patients with NQRS(HF) (p <0.001). LVAT exceeded 100 ms in 47 of 54 patients. In patients with RBBB(HF), QRS duration did not differ from that in patients with LBBB(HF), but LVAT (100 +/- 24 ms) was shorter (p <0.001). In 17 of 31 patients with RBBB(HF) LVAT was <100 ms (82 +/- 12), similar to those with NQRS(HF) (p = NS), indicating no LV conduction delay. However, in 7 of 31, LVAT (135 +/- 13 ms) was similar to that in patients with LBBB(HF) (p = NS). LVAT correlation with QRS duration varied (control p = 0.004, NQRS(HF) p = 0.15, RBBB(HF) p = 0.01, LBBB(HF) p <0.001). In conclusion, LV conduction delays in patients with HF varied with QRS configuration and duration, exceeding 100 ms in only 23% of patients with narrow QRS configuration and 45% with RBBB(HF) compared with 87% with LBBB(HF). Fewer than 25% of patients with RBBB(HF) demonstrated delays equivalent to those in patients with LBBB(HF.) These variations may affect efficacy to cardiac resynchronization therapy.
左心室激活延迟（LVAT）>100毫秒可能决定心脏再同步治疗的反应，但其发生率以及与QRS形态的关系尚不清楚。将30名对照者的QRS时限和LVAT与120名心力衰竭（HF；左心室射血分数23±8%）患者进行比较，这些心力衰竭患者的QRS时限<120毫秒（NQRS(HF)，n = 35）或≥120毫秒（左束支传导阻滞[LBBB(HF)]，n = 54；右束支传导阻滞[RBBB(HF)]，n = 31）。LVAT通过从QRS起始点到左心室基底后外侧去极化的间期来估算。在对照者中，QRS时限为82±13毫秒，LVAT为55±18毫秒。LVAT始终<100毫秒。在NQRS(HF)患者中，与对照者相比，QRS时限（104±10毫秒）和LVAT（82±22毫秒）延长（p<0.001）。35名患者中有8名LVAT超过100毫秒。在LBBB(HF)患者中，与对照者和NQRS(HF)患者相比，QRS时限（161±29毫秒）和LVAT（136±33毫秒）延长（p<0.001）。54名患者中有47名LVAT超过100毫秒。在RBBB(HF)患者中，QRS时限与LBBB(HF)患者无差异，但LVAT（100±24毫秒）较短（p<0.001）。31名RBBB(HF)患者中有17名LVAT<100毫秒（82±12），与NQRS(HF)患者相似（p = 无显著性差异），表明无左心室传导延迟。然而，31名患者中有7名LVAT（135±13毫秒）与LBBB(HF)患者相似（p = 无显著性差异）。LVAT与QRS时限的相关性各不相同（对照者p = 0.004，NQRS(HF) p = 0.15，RBBB(HF) p = 0.01；LBBB(HF) p<0.001）。总之，心力衰竭患者的左心室传导延迟随QRS形态和时限而变化，QRS时限窄的患者中只有23%、RBBB(HF)患者中45%的LVAT超过100毫秒，而LBBB(HF)患者中这一比例为87%。RBBB(HF)患者中不到25%表现出与LBBB(HF)患者相当延迟。这些差异可能影响心脏再同步治疗的疗效。
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