心室传导阻滞模式对扩张型心肌病住院患者死亡率的影响：一项单中心队列研究
Effects of ventricular conduction block patterns on mortality in hospitalized patients with dilated cardiomyopathy: a single-center cohort study.
作者信息
Li Xiaoping, Luo Rong, Fang Wei, Xu Xiaolei, Niu Guodong, Xu Yixian, Fu Michael, Hua Wei, Wu Xiushan
机构信息
Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Hospital of the University of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China.
Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
出版信息
BMC Cardiovasc Disord. 2016 Jun 13;16:136. doi: 10.1186/s12872-016-0313-4.
BACKGROUND
Ventricular conduction blocks (VCBs) are associated with poor outcomes in patients with known cardiac diseases. However, the prognostic implications of VCB patterns in dilated cardiomyopathy (DCM) patients need to be evaluated. The purpose of this study was to determine all-cause mortality in patients with DCM and VCB.
METHODS
This cohort study included 1119 DCM patients with a median follow-up of 34.3 (19.5-60.8) months, patients were then divided into left bundle branch block (LBBB), right bundle branch block (RBBB), intraventricular conduction delays (IVCD) and narrow QRS groups. The all-cause mortality was assessed using Kaplan-Meier survival curves and Cox regression.
RESULTS
Of those 1119 patients, the all-cause mortality rates were highest in patients with IVCD (47.8, n = 32), intermediate in those with RBBB (32.9, n = 27) and LBBB (27.1 %, n = 60), and lowest in those with narrow QRS (19.9 %, n = 149). The all-cause mortality risk was significantly different between the VCB and narrow QRS group (log-rank χ2 = 51.564, P < 0.001). The presence of RBBB, IVCD, PASP ≥ 40 mmHg, left atrium diameter and NYHA functional class were independent predictors of all-cause mortality in DCM patients.
CONCLUSIONS
Our findings indicate that RBBB and IVCD at admission,but not LBBB, were independent predictors of all-cause mortality in patients with DCM.
背景
心室传导阻滞（VCB）与已知心脏病患者的不良预后相关。然而，扩张型心肌病（DCM）患者中VCB模式的预后意义需要评估。本研究的目的是确定DCM和VCB患者的全因死亡率。
方法
这项队列研究纳入了1119例DCM患者，中位随访时间为34.3（19.5 - 60.8）个月，患者随后被分为左束支传导阻滞（LBBB）、右束支传导阻滞（RBBB）、室内传导延迟（IVCD）和窄QRS波群组。使用Kaplan-Meier生存曲线和Cox回归评估全因死亡率。
结果
在这1119例患者中，IVCD患者的全因死亡率最高（47.8%，n = 32），RBBB患者（32.9%，n = 27）和LBBB患者（27.1%，n = 60）次之，窄QRS波群患者最低（19.9%，n = 149）。VCB组和窄QRS波群组之间的全因死亡风险有显著差异（对数秩χ2 = 51.564，P < 0.001）。RBBB、IVCD、肺动脉收缩压（PASP）≥40 mmHg、左心房直径和纽约心脏协会（NYHA）心功能分级是DCM患者全因死亡的独立预测因素。
结论
我们的研究结果表明，入院时的RBBB和IVCD，而非LBBB，是DCM患者全因死亡的独立预测因素。
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