摘要
目的:探讨左束支区域起搏(LBBAP)对三尖瓣反流(TR)的影响。方法:前瞻性入选2019年9月至2020年12月在中国医学科学院阜外医院本团队行LBBAP的缓慢性心律失常患者,术后定期随访超声心动图。按反流束面积/右心房面积比值的半定量法评估TR级别为无、轻、中、重度TR。TR进展定义为随访超声心动图评估的TR程度较术前进展至少一个等级。TR改善定义为随访超声心动图评估的TR程度较术前改善至少一个等级,中度或重度TR判断为有临床意义TR。结果:入选331例患者,303例患者完成随访,平均随访时间(6.63±4.57)个月。303例完成随访患者平均年龄(62.5±14.3)岁,男性167例(55.1%)。术前轻度以上TR患者137例(45.2%),包括102例轻度TR、26例中度TR和9例重度TR;术后随访发生TR患者126例(41.6%),包括97例轻度TR、24例中度TR和5例重度TR。术后TR无进展患者260例(85.8%),术后TR改善患者57例(41.6%),TR进展患者43例(14.2%),包括TR进展1级42例(13.9%)、进展2级1例(0.3%)。术后14例(4.6%)患者进展为有临床意义TR,术后出现新发TR患者29例(9.6%)。Logistic回归分析发现心房颤动是LBBAP后TR进展的危险因素(OR=2.749,95%CI:1.404~5.380,P=0.003);持续性心房颤动是导致术后出现有临床意义TR的危险因素(OR=7.212,95%CI:1.928~26.969,P=0.003)。结论:LBBAP可改善部分患者术前TR,少部分患者LBBAP后发生TR进展。心房颤动可能是LBBAP术后TR进展的影响因素。
Objectives:To investigate the impact of left bundle branch area pacing(LBBAP)on tricuspid regurgitation(TR).Methods:Patients with bradyarrhythmia,who underwent LBBAP from September 2019 to December 2020,were prospectively enrolled in this study.Patients were regularly followed-up after procedure.Echocardiography was performed before and after implantation of pacemaker.The grades of TR were evaluated by semi-quantitative method based on the ratio of reflux beam area to right atrium area,and defined as mild,moderate and severe TR.TR progression was defined as TR progressed at least one grade.TR improvement was defined as at least one grade reduction.Moderate or severe TR was viewed as TR with clinical relevance.Results:A total of 331 patients were enrolled,303 patients(167 males)completed post-procedure follow-up.The mean age was(62.5±14.3)years.Before LBBAP procedure,TR was found in137 patients(45.2%),including 102 patients with mild TR,26 patients with moderate TR and 9 patients with severe TR.During a mean of(6.63±4.57)months post-procedure follow-up,TR were detected in 126 patients(41.6%),including 97 patients with mild TR,24 patients with moderate TR and 5 patients with severe TR.TR remained unchanged in 260 patients(85.8%),improved in 57 patients(41.6%),and worsened in 43 patients(14.2%)including TR increase of one grade in 42 patients(13.9%)and increase of two grades in one patient(0.3%).TR worsening with clinical relevance was found in 14 patients(4.6%),and 29 patients developed new-onset TR(9.6%).Logistic regression analysis showed that atrial fibrillation was an independent risk factor for TR progression after LBBAP(OR=2.749,95%CI:1.404-5.380,P=0.003).Persistent atrial fibrillation was associated with increased risk of moderate or severe TR after LBBAP(OR=7.212,95%CI:1.928-26.969,P=0.003).Conclusions:LBBAP may improve or worsen TR in some patients.Atrial fibrillation might be associated with increased risk for TR progression after LBBAP.
作者
王倩
李晓飞
王钊
朱浩杰
樊晓寒
WANG Qian;LI Xiaofei;WANG Zhao;ZHU Haojie;FAN Xiaohan(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第12期1198-1204,共7页
Chinese Circulation Journal
基金
国家自然科学基金面上项目(81970284)。
关键词
左束支区域起搏
三尖瓣反流
导线相关性三尖瓣关闭不全
生理性起搏
left bundle branch area pacing
tricuspid regurgitation
lead related tricuspid regurgitation
physiological pacing
