摘要
目的:探讨术前自身QRS波时限(intrinsic QRS duration,IQRSd)对右心室心尖部(right ventricular apex,RVA)起搏患者心功能下降的预测作用。方法:选取因三度房室传导阻滞(Ⅲ°AVB)植入双腔全自动型起搏器(DDD)或单腔同步型起搏器(VVI)患者42例。其中,末次随访时左室射血分数较术前下降的绝对值(ΔLVEF)≥5%的患者22例(ΔLVEF≥5%组,DDD 12例,VVI 10例),同期ΔLVEF<5%患者20例(ΔLVEF<5%组,DDD 11例,VVI 9例),两组比较,研究起搏引起心功能下降的可能原因和可能的预测因子。每例患者在起搏器植入术前行12导联心电图和超声心动图检查,术后随访时记录起搏心电图、超声心动图及右心室累积起搏比例。结果:两组患者平均随访77.3个月,ΔLVEF≥5%组左室射血分数(left ventricular ejection fraction,LVEF)由术前(64.20±6.30)%降至(40.60±10.00)%(P<0.001),左房内径(left atrial diameter,LAD)由术前(34.77±6.42)mm增大至(41.00±7.45)mm(P<0.001),左室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)由术前(49.82±4.86)mm明显增大至(55.59±8.44)mm(P<0.001),差异均有统计学意义;ΔLVEF<5%组LVEF由术前(65.40±3.25)%降低至(64.94±3.00)%(P=0.543),LAD由术前(37.40±4.84)mm增加至(38.15±5.83)mm(P=0.347),LVEDD由术前(48.30±3.95)mm增加至(49.00±3.87)mm(P=0.090),变化均无统计学意义;四格表卡方检验提示植入起搏器后术前IQRSd≥110 ms组较术前IQRSd<110 ms组患者发生心功能下降比率更高(P=0.002);Kaplan-Meier分析发现植入起博器后术前IQRSd≥110ms患者较术前IQRSd<110 ms患者心功能下降发生时间更早。COX回归分析显示,术前IQRSd≥110 ms是左室收缩功能下降的独立预测危险因素(P<0.05)。结论:RVA长期起搏可引起心脏结构改变和左室收缩功能下降;术前IQRSd≥110 ms患者左室收缩功能下降发生率高且时间更早,术前IQRSd≥110 ms是起搏依赖患者左室收缩功能下降的独立预测危险因子。
Objective：To investigate the predictive value of intrinsic QRS duration （IQRSd） for left ventricular function deterioration in patients dependent on right ventricular apical （RVA） pacing. Methods：In this study,42 patients with third degree atrioventricular block who underwent pacemaker implantation were included. Twenty-two patients with absolute reduction value of left ventricular ejection fraction （ALVEF）≥5% after pacing （group with ALVEF≥5%） and 20 patients with ALVEF〈5% after pacing （group with ALVEF〈5% ） were enrolled to investigate the possible reasons or predictors for the cardiac function deterioration. The examination results of 12-lead electrocardiography and echocardiography,and clinical conditions were recorded for every patient before the implantation and during the follow-up. The cumulative pacing rate of pateints were also obtained at each follow-up visit. Results： After 77.3 months of follow-up,left ventrieular ejection fraction（LVEF） decreased significantly from （64.20 ± 6.30）% to （40.60±10.00）% （P 〈 0.001） while left atrial diameter （LAD） and left ventrieular end-diastolic dimension （LYEDD） enlarged significantly in group with ALVEF≥5%[LAD： （34.77 ± 6.42）mm vs. （41.00 ±7.45）mm;LVEDD： （49.82 ± 4.86）mm vs. （55.59 ± 8.44）mm;P 〈 0.001） ]. However,the average LVEF,LAD and LVEDD levels in group with ALVEF〈5% after pacing were not statistically different from those before pacing [LVEF： （65.40 ± 3.25）% vs. （64.94 ± 3.00）%;LAD： （37.40 ±4.84）mm vs. （38.15 ± 5.83）mm;LVEDD： （48.30± 3.95）mm vs. （49.00 ± 3.87）mm]. Kaplan-Meier analysis revealed that LVEF diminution after pacing appeared significantlyearlier in patients with IQRSd≥110 ms than that in patients with IQRS〈llO ms. Chi Square Test showed the rate of LVEF diminution was significantly higher in patients with IQRSd≥ 110 ms than that in patients with IQRSd 〈110 ms （P 〈 0.05）. COX regression analysis indicated t
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2012年第7期942-947,共6页
Journal of Nanjing Medical University(Natural Sciences)
基金
国家自然科学基金(81170162)
关键词
三度房室传导阻滞
右心室心尖部起搏
自身QRS波时限
心脏重构
心功能
third degree atrioventricular block
right ventricular apical pacing
intrinsic QRS duration
cardiac remodeling
cardiacfunction
