Peteiro Jesús, Bouzas-Mosquera Alberto, Broullón Javier, Yañez Juan, Martinez Dolores, Vazquez Jose Manuel
a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain ;
b Department of Information Technology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain.
Scand Cardiovasc J. 2016;50(2):108-13. doi: 10.3109/14017431.2015.1118529. Epub 2015 Dec 4.
Interpretation of the electrocardiogram (ECG) during exercise is not easy in patients with right bundle branch block (RBBB). Also, the value of exercise echocardiography (ExE) for predicting outcome in them has not been addressed. We sought to assess its prognostic value in patients with RBBB and known/suspected coronary disease.
Retrospective analysis of data on 703 patients with RBBB who were submitted to a clinically-indicated ExE. The end points were overall mortality and combined myocardial infarction and cardiovascular mortality.
During follow-up (4.1 ± 4.5 years) there were 130 deaths and 108 combined events. Independent predictors of combined events were history of coronary artery disease (hazard ratio [HR] = 2.37, 95% Confidence Interval [CI] = 1.24-4.52, p = 0.009) resting wall motion score index (HR = 2.14, 95% CI = 1.12-4.10, p = 0.02), metabolic equivalents (HR = 0.89, 95% CI = 0.93-0.97, p = 0.007), Δ in double product with exercise (HR = 0.96, 95% CI = 0.92-1.00, p = 0.036) and Δ in left ventricular ejection fraction (LVEF) with exercise (HR = 0.97, 95% CI = 0.94-0.99, p = 0.01). Neither positive clinical nor ECG exercise testing was predictive. Combined event rates were 3.3% in patients with ΔLVEF > 5%, 4.7% in those with ΔLVEF between 1-5% and 8.2% in those with no increase (Δ < 1%).
A decrease in LVEF during exercise is predictive of serious events in patients with RBBB.
对于右束支传导阻滞（RBBB）患者，运动期间的心电图（ECG）解读并不容易。此外，运动超声心动图（ExE）对预测其预后的价值尚未得到探讨。我们试图评估ExE在RBBB合并已知/疑似冠心病患者中的预后价值。
对703例接受临床指征ExE的RBBB患者的数据进行回顾性分析。终点为全因死亡率、心肌梗死合并心血管死亡率。
在随访期间（4.1±4.5年），有130例死亡和108例合并事件。合并事件的独立预测因素为冠状动脉疾病史（风险比[HR]=2.37，95%置信区间[CI]=1.24-4.52，p=0.009）、静息壁运动评分指数（HR=2.14，95%CI=1.12-4.10，p=0.02）、代谢当量（HR=0.89，95%CI=0.93-0.97，p=0.007）、运动时双乘积的变化量（HR=0.96，95%CI=0.92-1.00，p=0.036）以及运动时左心室射血分数（LVEF）的变化量（HR=0.97，95%CI=0.94-0.99，p=0.01）。临床阳性或心电图运动试验均无预测价值。LVEF变化量>5%的患者合并事件发生率为3.3%，LVEF变化量在1%-5%之间的患者为4.7%，无增加（变化量<1%）的患者为8.2%。
运动期间LVEF降低可预测RBBB患者发生严重事件。
