BACKGROUND:The cardiac resynchronization therapy (CRT) non-response rate can reach 30% in heart failure (HF) patients with left bundle branch block (LBBB). This study aimed to evaluate the value of baseline q waves in leads I, V5, or V6 in predicting response to CRT in patients with HF and LBBB.METHODS:Patients with HF (left ventricular ejection fraction ≤35%) and LBBB receiving CRT implantation were retrospectively enrolled. Baseline characteristics and electrocardiogram parameters, including lateral and left precordial q waves were evaluated. Non-response to CRT was defined as the improvement of left ventricular ejection fraction (LVEF) < 5% at a 6-month follow-up.RESULTS:A total of 132 patients (mean age 63.0 ± 10.4 years, 94 [71.2%] male) were included. Among them, 32 patients with q waves in leads I, V5, or V6 were classified into the qLBBB (+) group, and the rest without q waves in these leads were defined as the qLBBB (-) group. The CRT non-response rate in the qLBBB (+) group was markedly higher than that in the qLBBB (-) group (68.8% vs. 33.3%, p < .001). Multivariable logistic regression analysis revealed that the presence of baseline q waves in leads I, V5, or V6 remained significantly associated with a higher rate of CRT non-response in patients with HF and LBBB (odds ratio: 4.8, 95% confidence interval: 1.5-15.0, p = .007).CONCLUSION:Any q wave in leads I, V5, or V6 was an independent predictive factor for CRT non-response in patients with HF and LBBB.

目的:分析完全性左束支传导阻滞(complete left bundle branch block,CLBBB)患者中avL导联q波的发生率、形态特征及其与门控单电子发射型计算机断层心肌灌注显像(single-photon emission computed tomography myocardial perfusion imaging,SPECT-MPI)检查及冠状动脉造影(coronary angiography,CAG)或冠状动脉计算机断层血管造影(coronary computed tomography angiography,CCTA)所诊断的器质性心脏病(organic heart disease,OHD)的相关性.方法:回顾性分析1 882例标准12导联心电图诊断的CLBBB患者并收集其SPECT-MPI、CAG及CCTA的信息.测量心电图中avL导联QRS时限及振幅、q波时限及振幅,分析q波与器质性心脏病的相关性.结果:最终入选了157例患者,证实伴有OHD的患者122例(77.8％),其中avL导联出现q波者56例(45.9％).avL导联q波出现预测OHD的特异性及阳性预测值分别是97.1％和98.2％.与avL导联q波缺失且伴有OHD的CLBBB患者相比,avL导联出现q波的患者SPECT-MPI所测得的左心室收缩末容积(end systolic volume,ESV)和舒张末容积(end diastolic volume,EDV)显著升高(P均＜0.001),而左心室射血分数(left ventricular ejection fraction,LVEF)显著下降(P＜ 0.001).散点图和线性相关性分析显示CLBBB患者avL导联q波的时限、振幅和面积与SPECT-MPI所测得的左心室ESV、EDV和LVEF无线性相关性.结论:CLBBB患者avL导联出现q波与严重的左心室病变有关,但q波的时限、振幅及面积与左心室病变严重度无线性相关性.

Objective:To analyze the causes and predispositions of gastrointestinal (GI) major bleeding after taking oral anticoagulants (OAC) in patients with atrial fibrillation (AF) .Methods:AF patients with GI major bleeding after taking OAC in the AF anticoagulation clinic in First Aftiliated Hospital of Nanjing Medical University from March 2017 to June 2019 were enrolled in the study and the related information was collected. In this study, major bleeding was defined according to the International Association of Thrombosis and Hemostasis (ISTH) criteria, as clinically overt bleeding accompanied by a decrease in the hemoglobin level of at least 2 g/dL or transfusion of at least 2 units of packed red cells, occurring at a critical site, or resulting in death.Results:Among 410 AF patients who were admitted to our AF anticoagulation clinic, 11 suffered from GI bleeding during OAC. The mean age of the 11 patients was (70.4±5.9) years. The mean CHA 2DS 2-VASc score was 2.8±2.1, and the mean HAS-BLED score was 1.5±0.9. Seven patients (63.6%) took warfarin, 3 patients (27.3%) took dabigatran 110 mg bid, and 1 patient (9.1%) took rivaroxban 10 mg qd. Of the patients taking warfarin, 5 patients (83.3%) had an INR of >3.0 on the day GI major bleeding occurred. One patient (9.1%) concomitantly used non-steroidal anti-inflammatory drugs (NSAIDs) before bleeding, and one patient (9.1%) concomitantly used antiplatelet drugs. Nine patients went through gastrointestinal endoscopy after bleeding. The endoscopic investigation revealed that there were 3 cases of malignant tumor (33.3%) , 2 cases of benign ulcer (22.2%) , 1 case of small intestinal polyps (11.1%) , and 1 case of Dieulafoy disease (11.1%) . Conclusion:OAC may increase the risk of GI bleeding in AF patients, but to optimize the management of OAC, such as increasing times for INR in the target range in patients on warfarin and avoiding the predispositions of bleeding, can reduce the risk. Moreover, there is a high possibility of finding underlying GI diseases, especially malignant tumors after bleeding. Therefore, the importance and necessity of GI endoscopy after bleeding must be emphasized.