Nonischemic Dilated Cardiomyopathy: Results of Noninvasive and Invasive Evaluation in 310 Patients and Clinical Significance of Bundle Branch Block
Nonischemic Dilated Cardiomyopathy: Results of Noninvasive and Invasive Evaluation in 310 Patients and Clinical Significance of Bundle Branch Block
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DOI：
10.1111/j.1540-8159.2008.01199.x
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发表时间：
2008-11-01
影响因子：
1.8
通讯作者：
Juilliere, Yves
中科院分区：
文献类型：
--
作者：
Brembilla-Perrot, Beatrice;Alla, Francois;Juilliere, Yves
背景：有束支传导阻滞(BBB)的特发性扩张型心肌病(IDCM)患者在纽约心脏协会(NYHA)的III和IV期患者的存活率比无BBB的患者低。本文旨在探讨IDCM和NYHA I、II级患者中LBBB或RBBB的发生率及其临床意义。方法：连续收集310例IDCM患者的临床资料，随访4.8+/-3.7年。结果：76例(25%)患者有LBBB，21例(7%)有RBBB，212例无BBB。血脑屏障患者年龄大于其他患者(P<；0.009)。LBBB患者的左心室射血分数(LVEF)明显低于RBBB和其他患者(P<；0.05)。BBB患者晕厥的发生率高于无BBB患者(P<；0.05)。在有无血脑屏障的情况下，自发性室性心动过速(VT)和房颤的发生率、VT的诱发、总的心脏事件和猝死的发生率相似。结论：25%的IDCM患者存在LBBB，而RBBB很少见。合并BBB的患者年龄较大，晕厥发生率较高，LBBB患者的LVEF低于RBBB或无BBB患者。血脑屏障不会增加自发性室性心动过速、室性心动过速诱发或猝死的风险，并倾向于增加因心力衰竭和心脏移植指征而死亡的人数。(Pace 2008；31：1383-1390)
Background: The survival of patients with idiopathic dilated cardiomyopathy (IDCM) at III and IV stages of New York Heart Association (NYHA) is decreased in those with a bundle branch block (BBB) compared to those without BBB. Less is known on the prognosis of patients at earlier stages of NYHA and who had a left BBB (LBBB) or right BBB (RBBB).We sought to evaluate the prevalence and the clinical significance of LBBB or RBBB in patients with IDCM and classes I and II of NYHA.Methods: Clinical data, noninvasive, and invasive studies were consecutively collected in 310 patients, with IDCM, followed up to 4.8 +/- 3.7 years.Results: Seventy-six patients (25%) had LBBB, 21 (7%) had RBBB, and 212 had no BBB. Patients with BBB were older than other patients (P < 0.009). Left ventricular ejection fraction (LVEF) was lower in LBBB than in RBBB and other patients (P < 0.05). Syncope was more frequent in BBB than in absence (P < 0.05). Incidence of spontaneous ventricular tachycardia (VT) and atrial fibrillation, VT induction, total cardiac events, and sudden death were similar in the presence or absence of BBB. Deaths by heart failure and heart transplantations tended to be more frequent in BBB than in absence.Conclusions: LBBB was present in 25% of patients with IDCM; RBBB was rare. Patients with BBB were older and had more frequent syncope than patients without BBB; LVEF was lower in LBBB than in RBBB or in absence of BBB. BBB did not increase the risk of spontaneous VT, VT induction, or sudden death, and tended to increase deaths by heart failure and the indications of heart transplantation. (PACE 2008; 31: 1383 - 1390)