术后左束支部阻断对左心室重塑的影响 经过跨apical心跳隔膜肌切除术后的左心室重塑
Xueqing Cheng1, Jeffrey B Geske2, Wei Zhou1
1Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Hypertrophic Cardiomyopathy in Hubei Province, Wuhan, China.
The Journal of thoracic and cardiovascular surgery
|June 27, 2025
概括
大多数 (63%) 患有阻塞性缩性心肌病的患者在隔膜肌切除术后会出现左束枝块,但大多数病例显示左心室重塑良好. 手术前的压力和QRS持续时间预测了更糟糕的结果.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 电子生理学 电子生理学
背景情况:
- 阻塞性增高性心肌病 (oHCM) 是一种遗传性心脏病.
- 穿式心跳隔膜肌切除术是oHCM的一种手术选择.
- 左捆支部阻塞 (LBBB) 可能发生在手术后,影响心脏功能.
研究的目的:
- 在oHCM患者中确定隔膜肌切除术后新发LBBB的发生率.
- 评估LBBB对左心室 (LV) 重塑的影响.
- 为了确定不良LV转型后肌肉切除术的预测因素.
主要方法:
- 分析了286名经过横管隔膜肌切除术的oHCM患者.
- 术后的LBBB发生率和LV重塑在各组之间进行了比较.
- 基于 Septal 应变的分期分类了 LBBB 严重程度和影响.
- 多变量逻辑回归确定了不利重塑的预测因素.
主要成果:
- 63%的患者在肌肉切除术后出现了新发的LBBB.
- 在LBBB组,QRS持续时间较长,峰值应变分散.
- 阶段LBBB3与更严重的LV菌株,电阻延迟和心力衰竭住院治疗有关.
- 在手术前预测的全球纵向应变和QRS持续时间 阶段 LBBB 3.
结论:
- 在隔膜肌切除术后,新发起的LBBB很常见,但通常会导致轻微的LV机械变化 (阶段1-2).
- 大多数LBBB患者表现出显著的LV反向重塑,类似于非LBBB患者.
- 术前因素,如全球纵向应变不足和QRS持续时间长,预测严重的LBBB和不良的LV重塑.
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