| Background:Complete right bundle branch block is a common heart indoor conduction block,and it is one of the common type of slow arrhythmia.People ever think complete right bundle branch block as a benign cardiac arrhythmia,has no serious harm to human body,and it doesn’t cause enough attention in clinical significance like the atrioventricular block and left bundle branch block.In recent years,according to research reported,complete right bundle branch block can affect the general population and the prognosis in most of the patients.In fact,as a double-chamber electric machinery activity,the right bundle branch is one of the important transmission route of synchronicity,whether its transmission functions is fine,has a certain influence on heart function in patients.At the same time,the existence of right bundle branch block can be an independent predictor of cardiac events and long-term prognosis in certain disease.Therefore,it is necessary to further study the clinical significance of completeness right bundle branch block.Objectives:Analyze the correlation of QRS duration with Brain natriuretic peptide(BNP),Left ventricular ejection fraction(LVEF)and some cardiac ultrasound indexes in complete right bundle branch block patients,so as to evaluate its application value in complete right bundle branch block patients,as well as the evaluation of cardiacfunction.Methods:Collect 239 cases diagnosed with complete right bundle branch block(CRBBB)by ECG diagnosis center in cardiology of hospitalized cases from January 2014 to December 2014 in the first hospital affiliated to Dalian Medical University.Patients are divided into sinus rhythm with complete right bundle branch block(161 cases)and atrial fibrillation combined with complete right bundle branch block(78 cases).In the two groups,analyze the correlation of QRS interval changes with Brain natriuretic peptide(BNP),Left ventricular ejection fraction(LVEF),LVD(Light ventricular diameter),LAD(Light atrium diameter),RVD(Right ventricular diameter),RAD(Right atrium diameter)in complete right bundle branch block patients.Analyze whether there are some correlation between the QRS interval and cardiac function,as well as a criterion for evaluation of cardiac function.Results:Analyze the baseline data of 239 patients,male and female ratio is about 2:1,mean age is 68.88±12.36 years old,and there is a higher percentage of patients with coronary heart disease,hypertension,cardiac insufficiency,61.9%,60.3% and 34.7%,respectively.And proportion of patients with myocardial infarction(MI)is also bigger than other diseases,at 22.6%.239 patients are divided into CRBBB in sinus rhythm(161 cases)and atrial fibrillation combined complete CRBBB(78 cases).In the two groups,according to the interval of QRS wave,divide CRBBB in sinus rhythm into group A(120 ms ≤QRS < 135 ms)and group B(135 ms ≤ QRS < 150 ms),group C(QRS≥150 ms),and divide atrial fibrillation combined with CRBBB into group A(120ms ≤QRS < 135 ms),group B(135 ms ≤ QRS < 150 ms),group C(QRS≥150 ms),and analyze the correlation of QRS duration and the BNP,LVEF,LVD,LAD,RVD and RAD respectively.In CRBBB patients in sinus rhythm,the three groups have no statistical difference in gender,history of hypertension,coronary heart disease,MI,rheumatic heart disease,valvular heart disease,cardiomyopathy,but have the statistical differencein the aspect of whether combined with cardiac insufficiency and age,p = 0.005 and p =0.017 respectively.One-way analysis of variance: from group A to group C,with the increase of QRS duration increasing,the average of LVEF tends to decrease,the average of LVD and LAD tends to increase,BNP,RAD and RVD have no obvious correlation trend.Chi-squared test or nonparametric rank and inspection test(Kruskal-Wallis Test): LVEF,LVD and LAD of three groups has difference in statistical significance(p< 0.05),BNP,RAD and RVD have no difference in statistical significance(p>0.05).Spearman or Pearson is used to analyze the correlation of QRS duration and the BNP,LVEF,LVD,LAD,RAD,RVD,the result shows: the QRS duration with LVEF(r=-0.350,p<0.001)is negatively correlated,LVD(r=0.386,p<0.001)、LAD(r=0.325,p<0.001)are positively correlated,BNP(r=0.107,p=0.248>0.05),RAD(r=0.126,p=0.108>0.05),RVD(r=0.056,p=0.503﹥0.05)have no correlation.In atrial fibrillation combined with CRBBB groups,the three groups have no statistical difference in gender,age,history of hypertension,coronary heart disease,MI,rheumatic heart disease,valvular heart disease,cardiomyopathy,but have the statistical difference in the aspect of whether combined with cardiac insufficiency,p =0.01,the difference is significant.One-way analysis of variance: from group A to group C,with the increase of QRS duration increasing,the average of LVEF tends to decrease,BNP,LVD,LAD and RAD tend to increase,and RVD tends to reduce after increase.Chi-squared test or nonparametric rank and inspection test(Kruskal-Wallis Test):LVEF,BNP,LVD,RAD and RVD of three groups have difference in statistical significance(p< 0.05),LAD have no difference in statistical significance(p > 0.05).Spearman or Pearson is used to analyze the correlation of QRS duration and the BNP,LVEF,LVD,LAD,RAD,RVD,the result shows: LVEF(r =-0.366,p= 0.002)is negatively correlated.,and BNP(r = 0.246,p = 0.045),LVD(r = 0.431,p = 0.001),LAD(r = 0.265,p = 0.024),RAD(r = 0.322,p = 0.006),RVD(r = 0.380,p = 0.001)are all positively correlated.Conclusion:In patients with CRBBB,with the increasing of QRS duration,LVEF gradually tends to reduce,and LVD gradually tends to increase,so the QRS duration may have implications in the evaluation of cardiac function,and may been a preliminary evaluation in severity of the illness and early risk especially for patients with organic heart disease.The significantly extend in QRS duration(QRS duration≥150 ms),LVEF reduces significantly.In patients with atrial fibrillation combined with CRBBB,with the increase of QRS duration,the BNP,RAD and RVD also show the obvious positive correlation,which prompts that right ventricular function may be damaged. |
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