在心力衰竭中,早期的左束枝节奏有轻微减少的射出分数和左束枝阻塞
Jiaxin Zeng1, Chen He2, Fengwei Zou3
1Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Heart rhythm
|July 26, 2023
概括
早期左束枝节奏 (LBBP) 显著改善心脏功能,并减少心力衰竭的不良事件,轻微减少喷射率 (HFmrEF) 的患者已经离开了捆束枝块 (LBBB). 这种早期干预为这个患者群体提供了一个有前途的治疗选择.
科学领域:
- 心脏病学 心脏病学
- 电力生理学 电力生理学
- 心脏衰竭管理的管理
背景情况:
- 左捆枝节奏 (LBBP) 是有效的重同步心脏功能心力衰竭 (HF) 患者减少喷射率 (EF) 和左捆枝节阻塞 (LBBB).
- 关于早期LBBP在患有HF和轻度降低EF (HFmrEF) 的患者中有效性的数据有限,这些患者也患有LBBB.
研究的目的:
- 在被诊断为HFmrEF和LBBB的患者中调查早期LBBP的有效性.
主要方法:
- 连续HFmrEF患有LBBB的患者可能被纳入早期LBBP组 (LBBP+指南导向医学治疗[GDMT]) 或单独GDMT组.
- 评估左心室喷射分数 (LVEF),左心室终端透析直径 (LVEDD),纽约心脏协会 (NYHA) 功能分类和N-终端亲脑尿素 (NT-proBNP) 的变化.
- 评估临床事件,包括HF再住院或昏迷,并进行亚组分析,比较仅LBBB患者与并发症或晚期加多增强 (LGE) 患者.
主要成果:
- 早期LBBP组在6个月的GDMT组相比,在LVEF (+14.75%vs-2.42%),LVEDD减少 (-7.51mmvs-0.87mm) 和NYHA分类 (-0.84vs-0.13) 中显示出明显更大的改善.
- 早期LBBP在约20.7个月的随访期间显示了临床事件的显著减少 (0.0%与40.0%相比).
- 与LBBB-Combined分组相比,LBBB-Only分组的患者在LVEF改善和LVEDD减少方面从LBBP中获得了更大的好处.
结论:
- 早期LBBP与GDMT相结合,在患有LBBB的HFmrEF患者中,与单独使用GDMT相比,导致心脏功能得到更好的改善.
- 早期LBBP显著减少了这种患者群体的不良临床事件.
- 在没有并发症或LGE的LBBB患者中,LBBP的益处可能更明显.
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