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【文摘发布】左束支传导阻滞心衰患者的高死亡
Fariborz Tabrizi1,*,,, Anders Englund2, Mårten Rosenqvist3, Lars Wallentin4 and Ulf Stenestrand5,
1 Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, S-141 86 Stockholm, Sweden
2 Department of Cardiology, Örebro University Hospital, Örebro, Sweden
3 Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden
4 Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
5 Department of Cardiology, University Hospital, Linköping, Sweden
Background: The purpose of this study was to assess the independent contribution of left bundle branch block (LBB on long-term mortality in a large cohort with symptomatic heart failure (HF) requiring hospitalization.
Methods and Results: We studied a prospective cohort of 21 685 cases of symptomatic HF requiring hospitalization in the Register of Information and Knowledge about Swedish Heart Intensive care Admissions in 1995–2003. Long-term mortality was evaluated by Logistic regression analysis, adjusted for multiple covariates that could influence long-term prognosis. LBBB was present in 20% (4395 of 21 685) of HF admissions. Patients with LBBB had a higher prevalence of cardiac comorbid conditions than patients with no LBBB. 1-, 5-, and 10-year mortality was 31.5 vs. 28.4%, 69.3 vs. 61.3%, and 90.1 vs. 84.7% for HF patients with and without respectively LBBB. When adjusting for comorbidity, LBBB was associated with increased 5-year mortality (OR, 1.21; 95% CI, 1.10–1.35; P < 0.001). When left ventricular ejection fraction was included in the analysis LBBB had no longer any independent influence on 5-mortality (OR, 0.99; 95% CI, 0.62–1.56; P = 0.953).
Conclusion: LBBB occurs in 1/5 in HF patients requiring hospitalization and is associated with a very high mortality. However, the high long-term mortality appears to be caused by cardiac comorbidities and myocardial dysfunction rather than the LBBB per se.
Key Words: Heart failure • Bundle branch block • Prognosis
European Heart Journal 2007 28(20):2449-2455; doi:10.1093/eurheartj/ehm262 EHJ Contents: Volume 28, Number 20 : October 2007
Influence of left bundle branch block on long-term mortality in a population with heart failure
左束支传导阻滞对心衰患者长期死亡率的影响
Fariborz Tabrizi1,*,,, Anders Englund2, Mårten Rosenqvist3, Lars Wallentin4 and Ulf Stenestrand5,
1 Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, S-141 86 Stockholm, Sweden
2 Department of Cardiology, Örebro University Hospital, Örebro, Sweden
3 Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden
4 Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
5 Department of Cardiology, University Hospital, Linköping, Sweden
Background: The purpose of this study was to assess the independent contribution of left bundle branch block (LBBB) on long-term mortality in a large cohort with symptomatic heart failure (HF) requiring hospitalization.
背景：该研究目的是在需要住院的有症状心力衰竭 (HF)大样本人群中，评估左束支传导阻滞(LBBB)对患者长期死亡率的独立影响。
Methods and Results: We studied a prospective cohort of 21 685 cases of symptomatic HF requiring hospitalization in the Register of Information and Knowledge about Swedish Heart Intensive care Admissions in 1995–2003. Long-term mortality was evaluated by Logistic regression analysis, adjusted for multiple covariates that could influence long-term prognosis. LBBB was present in 20% (4395 of 21 685) of HF admissions. Patients with LBBB had a higher prevalence of cardiac comorbid conditions than patients with no LBBB. 1-, 5-, and 10-year mortality was 31.5 vs. 28.4%, 69.3 vs. 61.3%, and 90.1 vs. 84.7% for HF patients with and without respectively LBBB. When adjusting for comorbidity, LBBB was associated with increased 5-year mortality (OR, 1.21; 95% CI, 1.10–1.35; P < 0.001). When left ventricular ejection fraction was included in the analysis LBBB had no longer any independent influence on 5-mortality (OR, 0.99; 95% CI, 0.62–1.56; P = 0.953).
方法和结果：收集1995–2003 年在瑞典心脏重症监护登记资料库中的21 685例需要住院的有症状HF患者。调整了影响长期预后的相关变量后，由Logistic回归分析长期死亡率。 20% (4395 / 21 685) 的 HF患者出现LBBB。与没有LBBB的患者相比，伴有LBBB的HF患者心脏并发症的发病率更高。有或无LBBB的HF患者的1年、 5年和 10年死亡率分别是 31.5 vs. 28.4%, 69.3 vs. 61.3%, 和 90.1 vs. 84.7% 。调整并发症之后， LBBB与5年死亡率增加有关(OR, 1.21; 95% CI, 1.10–1.35; P < 0.001)，将左室射血分数纳入分析后，LBBB对5年死亡率不再有任何独立影响。 (OR, 0.99; 95% CI, 0.62–1.56; P = 0.953).
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作者:admin@医学,生命科学 2011-04-22 21:06
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