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目的探讨心电图QRS离散度(QRSD)对左束支传导阻滞(LBBB)患者左室收缩功能及心室非同步运动的评价情况。方法 42例心内科住院时发现的伴有LBBB的患者,按病因分为孤立性LBBB组(7例)和合并器质性疾病的LBBB组(35例),另选择28例正常人作为对照组。对比分析三组间超声心动图及心电图数据,包括左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、E/A比值、室间机械延迟时间(IVMD)、左心室收缩不同步指数(TS-SD)、QRSD、QRS间期(QRSd);LBBB两组QRSD、QRSd分别与超声心动图相关指标做多元相关性分析。结果 LBBB组与对照组比较,除孤立性LBBB组LVEDD外(P=0.145),其余指标差异均有统计学意义(P<0.05);LBBB两组之间比较,除QRSd外(P=0.175),其余指标差异亦有统计学意义(P<0.05);LBBB两组QRSd与QRSD均与LVEF呈负相关,其中QRSd的相关系数为-0.310(P=0.046),QRSD的相关系数为-0.341(P=0.027);QRSD与TS-SD呈正相关,其相关系数为0.318(P=0.040),其余指标相关性不强。结论心电图QRS离散度对评价LBBB患者左室收缩功能损害方面有参考价值,对评价心室非同步运动方面作用有待于进一步研究确定。
Objective To investigate the assessment of left ventricular systolic function and ventricular nonsynchrony in patients with left bundle branch block (LBBB) by QRS dispersion. Methods A total of 42 LBBB patients with cardiology found in hospital were divided into two groups: solitary LBBB group (7 cases) and LBBB group (35 cases) with organic disease, and another 28 healthy subjects were selected as control group . Echocardiography and electrocardiogram data including the left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), E / A ratio, IVMD, and left ventricular systolic dyssynchrony Index (TS-SD), QRSD and QRSd (QRSd); QRD and QRSd of LBBB were correlated with echocardiographic indices respectively. Results Compared with LBBB group, except for LVEDD in solitary LBBB group (P = 0.145), there were significant differences in other indexes between LBBB group and control group (P <0.05) (P <0.05). The QRSd and QRSD of LBBB were negatively correlated with LVEF, the correlation coefficient of QRSd was -0.310 (P = 0.046), the correlation coefficient of QRSD was -0.341 (P < P = 0.027). There was a positive correlation between QRSD and TS-SD, the correlation coefficient was 0.318 (P = 0.040), and the other indicators were not correlated. Conclusions ECG QRS dispersion has a reference value in evaluating left ventricular systolic dysfunction in patients with LBBB. The role of ECG QRS dispersion in the evaluation of ventricular nonsynchronous exercise needs to be further studied and confirmed.