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在TAVR后新发LBBB患者中,LV功能障碍和异步的患病率和进展

Andrei D Margulescu¹, Dewi E Thomas², Magid Awadalla³

¹Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.

Cardiovascular revascularization medicine : including molecular interventions

|April 11, 2024

概括

经过过导管大动脉置换 (TAVR) 后新出现的左束分支阻塞 (N-LBBB) 立即降低心脏功能. 持续的N-LBBB可能会导致更糟糕的结果,特别是在基线心脏功能较好的患者中.

科学领域:

心脏病学心脏病学
心脏电生理学心脏电生理学
干预心脏病学干预心脏病学

背景情况:

新发病的左捆支部阻塞 (N-LBBB) 是经过过导管大动脉置换 (TAVR) 后的一个已知的并发症.
在TAVR后,N-LBBB对心脏功能和机械失调的确切影响仍然不完全理解.
慢性LBBB (C-LBBB) 患者与发展N-LBBB的患者相比,具有明显的基线特征.

研究的目的:

为了研究新发病的左束分支阻塞 (N-LBBB) 对TAVR后心脏功能和机械失调的影响.
为了比较患有持续性N-LBBB,暂时性N-LBBB和TAVR后慢性LBBB (C-LBBB) 的患者之间的结果.
在TAVR后发展N-LBBB的患者中识别左心室功能障碍的预测因子.

主要方法:

对409名接受TAVR的患者的回顾性分析,确定38名患有N-LBBB,17名患有C-LBBB.
在基线,早期TAVR后和晚期随访时进行心声学评估,以评估LV质量,体积,LVEF,GLS和机械失调.
排除需要TAVR后刺激的患者.

主要成果:

N-LBBB患者在TAVR后早期表现出轻微的异步和减少的LVEF/GLS.
持久的N-LBBB显示出渐进的异步,而C-LBBB则没有.
晚期随访时LVEF保持稳定,但基线LVEF较好的患者更容易发展N-LBBB诱导的LV功能障碍.
在TAVR后缺乏立即的LVEF改善预测后来的恶化.

结论:

在TAVR之后的N-LBBB会导致心脏功能立即减少,即使是轻微的异步.
持久的N-LBBB带来了LBBB诱导的LV功能障碍的风险,特别是在最初心脏功能良好的患者中.
过渡性N-LBBB通常会随着心脏功能恢复到基线水平而消失.

关键词:

不同步的时间变化.左捆的分支区块的分支区块.左心室的功能是没有的.新发病的开始.通过导管更换大动脉门.

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