左束支传导阻滞患者心力衰竭的流行病学及进化特征——一项基于摩洛哥中心的研究
Epidemiological and evolutionary characteristics of heart failure in patients with left bundle branch block - A Moroccan center-based study.
作者信息
Bouqata N, Kheyi J, Miftah F, Sabor H, Bouziane A, Bouzelmat H, Chaib A, Benyass A, Moustaghfir A
机构信息
Department of Intensive Care and Rhythmology, Mohammed V Military Hospital, Rabat, Morocco.
Biostatistics Laboratory, Epidemiological and Clinical Research, Faculty of Medicine and Pharmacy, Rabat, Morocco.
出版信息
J Saudi Heart Assoc. 2015 Jan;27(1):1-9. doi: 10.1016/j.jsha.2014.08.001. Epub 2014 Aug 28.
BACKGROUND
In patients with heart failure, left bundle branch block (LBBB) seems to be associated with an increased risk of cardiovascular mortality.
PURPOSE
The purpose of this study is to determine the in-hospital outcome of congestive heart failure patients with LBBB versus those without.
METHODS
We conducted a prospective observational study at the Department of Intensive Care and Rhythmology at the Mohammed V Military Hospital of Rabat, where 330 patients were admitted for heart failure between January 2008 and September 2012. Screening out patients with missing data yielded a cohort of 274 patients. Among the 274 patients, only 110 had LBBB and a left ventricular ejection fraction lower than 50%. We randomly selected a subset of 110 patients diagnosed as non-LBBB to ensure a significant statistical comparison between LBBB and non-LBBB patients. We therefore considered two groups in our analysis: 110 heart failure (HF) patients with LBBB and 110 HF patients without LBBB. Patients with incomplete records were excluded.
RESULTS
Male gender was dominant in both groups (82.7% vs. 66.7%, p = 0.005). Patients with LBBB had a higher prevalence of idiopathic dilated cardiomyopathy (39.1% vs. 4.8%, p < 0.001); and a higher prevalence of previous hospitalization for heart failure (64.5% vs. 23.3%, p < 0.001). The left ventricular ejection fraction was significantly lower in the group with LBBB (25.49% vs. 39.53%, p < 0.001). Age, cardiovascular risk factors, rhythmic and thromboembolic complications did not significantly differ. In patients with LBBB, 61.8% received cardiac resynchronization therapy performed both during the index hospital stay (50.9%) and previously (10.9%). Hospital outcome was marked by 20 in-hospital deaths in the group with LBBB and eight deaths in the group without LBBB (p = 0.008).
CONCLUSION
Our analysis emphasizes increased in-hospital mortality and higher disease severity, over a short period of stay, in heart failure patients with left bundle branch block.
背景
在心力衰竭患者中，左束支传导阻滞（LBBB）似乎与心血管疾病死亡率增加有关。
目的
本研究的目的是确定患有LBBB的充血性心力衰竭患者与未患LBBB的患者的院内结局。
方法
我们在拉巴特穆罕默德五世军事医院的重症监护和心律科进行了一项前瞻性观察性研究，2008年1月至2012年9月期间有330例患者因心力衰竭入院。筛选出有缺失数据的患者后得到274例患者的队列。在这274例患者中，只有110例患有LBBB且左心室射血分数低于50%。我们随机选择了110例被诊断为非LBBB的患者作为子集，以确保LBBB组和非LBBB组患者之间有显著的统计学比较。因此，我们在分析中考虑了两组：110例患有LBBB的心力衰竭（HF）患者和110例没有LBBB的HF患者。记录不完整的患者被排除。
结果
两组中男性均占主导（82.7%对66.7%，p = 0.005）。LBBB患者特发性扩张型心肌病的患病率更高（39.1%对4.8%，p < 0.001）；既往因心力衰竭住院的患病率也更高（64.5%对23.3%，p < 0.001）。LBBB组的左心室射血分数显著更低（25.49%对39.53%，p < 0.001）。年龄、心血管危险因素、节律性和血栓栓塞并发症无显著差异。在LBBB患者中，61.8%接受了心脏再同步治疗，其中在本次住院期间进行的占50.9%，之前进行的占10.9%。院内结局表现为LBBB组有院内死亡20例，非LBBB组有8例死亡（p = 0.008）。
结论
我们的分析强调，患有左束支传导阻滞的心力衰竭患者在短时间住院期间院内死亡率增加且疾病严重程度更高。
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