关于左束支传导阻滞中塞尔维斯特QRS评分的保留意见——经导管主动脉瓣植入患者的经验

Reservations about the Selvester QRS score in left bundle branch block - Experience in patients with transcatheter aortic valve implantation.

作者信息

Poels Thomas T, Kats Suzanne, Veenstra Leo, van Ommen Vincent, Maessen Jos G, Prinzen Frits W

机构信息

Department of Cardiothoracic Surgery, Maastricht University Medical Center, PO Box 5800, Maastricht, The Netherlands.

Department of Cardiology, Maastricht University Medical Center, PO Box 5800, Maastricht, The Netherlands.

出版信息

J Electrocardiol. 2017 Mar-Apr;50(2):261-267. doi: 10.1016/j.jelectrocard.2017.01.002. Epub 2017 Jan 12.

DOI:10.1016/j.jelectrocard.2017.01.002

PMID:28126337

Abstract

BACKGROUND

The Selvester QRS score (S-score) estimates myocardial scar using electrocardiographic criteria. We evaluated the S-score for left bundle branch block (LBBB).

MATERIAL AND METHODS

Studied were 36 patients who developed persistent LBBB upon transcatheter aortic valve implantation (TAVI, TAVI-LBBB group) and 36 matched patients with persistent narrow QRS (TAVI-nQRS group). Electrocardiograms were recorded before and briefly after TAVI and during ~6months follow-up. S-score was calculated using criteria for hypertrophic (in absence of LBBB) or LBBB hearts.

RESULTS

In TAVI-LBBB patients correlation between S-scores pre-TAVI and post-TAVI was absent (R=0.023). High S-scores post-TAVI occurred in patients with low pre-TAVI scores. Pre-post TAVI scores correlated weakly in TAVI-nQRS (R=0.182), indicating a possible influence of ventricular unloading by TAVI. In both groups S-scores at post-TAVI and follow-up compared reasonably (R=0.389 and R=0.386), indicating reproducibility in more stable conditions.

CONCLUSION

This study indicates that the use of the LBBB S-score criteria overestimates scar size and that caution is recommended in the use of the score in patients with LBBB.

摘要

背景

塞尔维斯特QRS评分（S评分）采用心电图标准评估心肌瘢痕。我们评估了左束支传导阻滞（LBBB）的S评分。

材料与方法

研究对象为36例经导管主动脉瓣植入术（TAVI）后发生持续性LBBB的患者（TAVI-LBBB组）和36例匹配的持续性窄QRS患者（TAVI-nQRS组）。在TAVI术前、术后短时间内以及约6个月的随访期间记录心电图。使用肥厚型（无LBBB）或LBBB心脏的标准计算S评分。

结果

在TAVI-LBBB患者中，TAVI术前和术后的S评分之间无相关性（R=0.023）。术前S评分低的患者术后出现高S评分。TAVI-nQRS患者术前和术后评分的相关性较弱（R=0.182），表明TAVI可能对心室负荷有影响。在两组中，TAVI术后和随访时的S评分比较合理（R=0.389和R=0.386），表明在更稳定的条件下具有可重复性。