Bounhoure J P, Donzeau J P, Doazan J P, Queyreau J M, Galinier M, Estrabaud M, Puel J
Service de cardiologie du Pr Bounhoure, CHU Rangueil, Toulouse.
Arch Mal Coeur Vaiss. 1991 Feb;84(2):167-71.
Thirty-two complete bundle branch blocks were observed during 16,500 exercise stress tests between 1973 and 1988: there were 7 right bundle branch blocks and 25 left bundle branch blocks. Exercise stress testing was indicated in 15 cases for stable angina, in 15 cases for different functional disturbances and in 2 cases as a systematic investigation. All patients underwent coronary angiography and selective left ventriculography. Right bundle branch block occurring at a heart rate of 105 +/- 25/mn were associated with typical anginal pain at the time of apparition in 5 patients. Coronary angiography showed triple vessel disease in 3 cases, double vessel disease in 2 cases and an isolated proximal lesion of the left anterior descending artery in 2 cases. Left bundle branch block occurring at a heart rate of 125 +/- 12/mn was associated with normal coronary angiography in 7 cases. Eighteen patients had pathological coronary angiogrammes with severe lesions of the left anterior descending artery. Two women suffered from chest pain when the block developed and coronary angiography was normal in one of them. During follow-up (average 62 months), 16 coronary events were observed including 2 infarcts, and 6 patients developed cardiac failure. In conclusion, complete right bundle branch block appearing during exercise stress testing was constantly associated with atherosclerotic coronary artery disease. The predictive value of complete left bundle branch block on effort was 72%. Complete left bundle branch block occurring at heart rates of less than 120/mn was frequently associated with a proximal stenosis of the left anterior descending artery.
1973年至1988年期间，在16500次运动负荷试验中观察到32例完全性束支传导阻滞：其中7例为右束支传导阻滞，25例为左束支传导阻滞。15例因稳定型心绞痛、15例因不同功能障碍、2例作为系统检查而进行运动负荷试验。所有患者均接受了冠状动脉造影和选择性左心室造影。5例患者在心率为105±25次/分钟时出现右束支传导阻滞，同时伴有典型心绞痛。冠状动脉造影显示，其中3例为三支血管病变，2例为双支血管病变，2例为左前降支近端孤立病变。7例患者在心率为125±12次/分钟时出现左束支传导阻滞，冠状动脉造影正常。18例患者冠状动脉造影显示病变，左前降支严重病变。2例女性在束支传导阻滞发生时出现胸痛，其中1例冠状动脉造影正常。在随访期间（平均62个月），观察到16例冠状动脉事件，包括2例梗死，6例患者发生心力衰竭。总之，运动负荷试验中出现的完全性右束支传导阻滞常与动脉粥样硬化性冠状动脉疾病相关。完全性左束支传导阻滞对运动的预测价值为72%。心率低于120次/分钟时出现的完全性左束支传导阻滞常与左前降支近端狭窄相关。
