非侵入性起搏器负荷超声心动图对永久起搏器植入术后合并冠脉病变的临床诊断意义

目的：探讨非侵入起搏器负荷超声心动图对永久起搏器植入术后合并冠脉病变的临床诊断意义。方法：采用前瞻性研究,实验对象为24名因房室传导阻滞或慢性心房纤颤而植入永久起搏器的患者（男12人,女12人,平均年龄70.2±6.1岁）,所有患者均因不典型心绞痛入院和完全起搏依赖,心电图改变无法判断是否存在心肌缺血。通过体外程控进行非侵入性起搏器负荷超声心动图检测室壁运动幅度如左室射血分数评估心功能,检测后行冠脉造影术评估冠脉狭窄情况,及实验前后测定B型脑钠肽的变化。结果：24例患者中,有13例通过起搏器负荷超声心动图应激实验测得LVEF随起搏心率增加而降低,这其中又有11例患者通过冠状动脉造影证实其冠脉存在不同程度的狭窄,诊断的准确性84.62%;11例冠脉造影结果阳性的患者实验后30分钟测得的BNP水平较实验前明显升高。结论：非侵入性起搏器负荷超声心动图应激实验作为一种简单、快速、安全及具有诊断意义的方法,可用来评价植入起搏器术后完全起搏依赖,心电图继发性ST-T改变难以判断的心肌缺血,为进一步检查及治疗提供可靠临床数据。

The Clinical Diagnostic Significance of Noninvasive Pacemaker Stress Echocardiography on Coronary Artery Lesion after Permanent Pacemaker Implantation

Objective： To evaluate the clinical diagnostic significance of noninvasive pacemaker stress echocardiography on coronary artery lesion after permanent pacemaker implantation.Methods： A prospective study was used on 24 patients（12 men and 12 women,mean age：70.2±6.1 years） with atypical angina and a permanent pacemaker because of chronic atrial fibrillation or complete atrioventricular block and possible myocardial ischemia that was not able to be judged by electrocardiogram.Wall motion extents such as LVEF was used to evaluate cardiac function through non-invasive pacemaker load ultrasonic cardiogram,followed by coronary angiography to evaluate the severity of coronary stenosis,BNP was measured before and after the test.Results： In 24 patients,13 cases showed that LVEF reduced gradually with the rise of pacing,different degrees of coronary stenosis had been found in 11 cases of the 13 patients mentioned above,the diagnostic accuracy rate reached 84.62%,the serum BNP levels were significantly higher in these 11 patients 30 minutes after test than that before test.Conclusion： Changes of LVEF and BNP were simple,safe and accurate indicators by stress-pacing echocardiography for detecting coronary artery disease in patients with atypical angina and a permanent pacemaker.