| 摘要: |
| 目的 探讨经导管主动脉瓣置入术（TAVI）患者新发左束支传导阻滞（new-LBBB）对血流动力学及预后的影响。方法 回顾性分析浙江大学医学院附属第二医院2013年3月至2018年4月行TAVI的245例重度主动脉瓣狭窄患者资料。根据术后有无new-LBBB分为new-LBBB组（57例）和对照组（188例），收集患者入院时基线资料及术前、术后12个月超声心动图检查结果。研究终点为全因死亡，随访截止时间为2019年4月30日。生存分析采用Kaplan-Meier法和log-rank检验。结果 术前两组患者二尖瓣反流积分和左心室射血分数差异均无统计学意义（P均>0.05）；术后12个月new-LBBB组左心室射血分数低于对照组[59.20%（53.70%，64.58%）vs 64.90%（60.17%，68.45%）]，二尖瓣反流积分高于对照组[1.16（0.44，1.84）分vs 0.82（0.27，1.46）分]，差异均有统计学意义（Z=-4.267、-2.668，P均<0.01）。术后随访35.77（23.80，45.88）个月，new-LBBB组全因死亡率为10.5%（6/57），对照组为5.9%（11/188），差异无统计学意义（χ2=1.48，P=0.238）。结论 TAVI术后new-LBBB影响患者的左心室射血分数，并诱发或加重二尖瓣关闭不全，但不影响患者的1年生存率。 |
| 关键词: 经导管主动脉瓣置换 新发左束支传导阻滞 存活率分析 左心室射血分数 二尖瓣反流 |
| DOI：10.16781/j.0258-879x.2020.12.1352 |
| 投稿时间：2020-04-02修订日期：2020-09-10 |
| 基金项目: |
|
| Influence of new-onset left bundle branch block on hemodynamics and prognosis after transcatheter aortic valve implantation |
| ZHOU Qin1,JIANG Jun2*,PU Zhao-xia2,LIU Xian-bao2,WANG Jian-an2 |
(1. Department of Clinical Medicine, Graduate School, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China;
2. Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the effects of new-onset left bundle branch block (new-LBBB) on hemodynamics and prognosis after transcatheter aortic valve placement (TAVI). Methods The data of 245 severe aortic stenosis patients who underwent TAVI from Mar. 2013 to Apr. 2018 in the Second Affiliated Hospital, Zhejiang University were retrospectively analyzed. Patients were divided into control group (188 cases) and new-LBBB group (57 cases) based on whether they had new-LBBB or not after TAVI. The baseline data were collected at admission, and the echocardiographic results were analyzed at preoperation and 12 months postoperation. The study endpoint was all-cause death, and the follow-up deadline was Apr. 30, 2019. Survival analysis was performed by Kaplan-Meier method and log-rank test. Results There were no significant differences in mitral regurgitation score or left ventricular ejection fraction (LVEF) between the two groups before operation (both P>0.05); 12 months postoperation, the LVEF of the new-LBBB group was significantly lower than that of the control group (59.20%[53.70%, 64.58%]vs 64.90%[60.17%, 68.45%]), and the mitral regurgitation score was significantly higher than that of the control group (1.16[0.44, 1.84]vs 0.82[0.27, 1.46]) (Z=-4.267, -2.668, both P<0.01). After 35.77 (23.80-45.88) months of follow-up, the mortality rate of the new-LBBB group was 10.5% (6/57) and that of the control group was 5.9% (11/188), with no significant difference (χ2=1.48, P=0.238). Conclusion New-LBBB after TAVI can affect LVEF, induces or aggravates mitral regurgitation, but has no influence on 1-year survival rate. |
| Key words: transcatheter aortic valve replacement new-onset left bundle branch block survival analysis left ventricular ejection fraction mitral regurgitation |
