右室间隔部起搏患者起搏QRS 波时限与心功能的关系

目的:探讨右室间隔部起搏患者起搏QRS波时限与心功能的关系。方法:回顾性分析植入右室间隔部起搏的双腔起搏器患者(111例),起搏器平均植入时间(4.52±3.65)年,通过常规体表心电图测得完全起搏时QRS波时限分为四组:A组为QRS≤120ms(21例);B组为120ms180ms(26例),行心脏彩色多普勒检查获取左房内径(LAD)、收缩末期左室内径(LVESD)、舒张末期左室内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及LVEF,同时检测患者的血清氨基末端脑肭肽前体(NT-proBNP),分析起搏QRS波时限与以上各指标的关系。结果:D组患者LAD、LVEDD、LVESD、IVST及IVPWT较其他三组明显增大,同时LVEF显著下降,NT-proBNP明显升高,有统计学意义(P<0.05)。同时发现随起搏QRS时限的不断增宽,不同组别的LVEF是依次降低(中位值分别为66.5%、60.3%、52.7%和45.8%),而血清NT-proBNP水平是依次增大(中位值分别为143.7 pg/ml、261.8 pg/ml、599.4 pg/m和971.2 pg/ml)。直线相关性分析示起搏QRS波时限与LAD(r=0.141,P<0.05)、LVEDd(r=0.678,P<0.05)、LVEDs(r=0.439,P<0.05)、IVST(r=0.165,P<0.05)及LVPWT(r=0.189,P<0.05)有显著线性关系,呈正相关。起搏QRS波时限与LVEF负相关(r=-0.684,P<0.05),起搏QRS波时限与NT-proBNP的对数正相关(r=0.368,P=0.029)。结论:对于右室间隔部起搏的双腔起搏患者,起搏QRS波时限是一个可初步判断心脏结构和功能的指标,其起搏QRS波时限延长可能会恶化患者的心脏结构及功能,可结合NT-proBNP进行动态观察,对起搏器植入患者的心功能恶化和心衰的预防有一定的临床实用价值。

Association between Paced QRS Duration and Cardiac Function in Patientswith Right Ventricular Septum Pacing

Objective: To investigate the relationship between paced QRS duration and cardiac function in patients with right ven-tricular septum pacing.Methods: A total of 111 dual-chamber pacemakers patients with right ventricular septum pacing were divided into four groups on paced QRS duration through conventional electrocardiogram measurement after implantation of pacemakers.The first group(group A) was QRS≤120ms,n=21;the second group(group B) was 120ms180ms,n=26.The paced QRS duration,NT-proBNP levels and some echocardiographic parameters such as left atrial dimension(LAD),left ventricular end-systolic dimension(LVESD),left ventricular end-diastolic dimension(LVEDD),interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT) and LVEF were measured.and assess the relationship between paced QRS duration and all kinds of parameters in the patients.Results: The LAD,LVEDD,LVESD,IVST and IVPWT in group D was significantly higher than the other group,meanwhile,the level of NT-pro-BNP stepped up remarkably and LVEF dramatically decreased following the other group(P<0.05).What is more,with the paced QRS duration widened,different groups of LVEF were ordinal reduced and the level of NT-proBNP were ordinal increased.The paced QRS duration was positively correlated to LAD(r =0.141,P<0.05),LVEDd(r=0.678,P<0.05),LVEDs(r=0.439,P<0.05),IVST(r=0.165,P<0.05)及LVPWT(r=0.189,P<0.05),and log(NT-proBNP)(r=0.368,P=0.029),and negatively correlated to LVEF(r=-0.684,P<0.05).Conclusion: In patients with right ventricular septum pacing.the paced QRS duration is a practical index for evaluating the cardiac structure and func-tion.The paced QRS duration was increased may cause its adverse effect on cardiac structure and function.If it can be combined with NT-pro BNP dynamically observation,maybe have a certain clinical practical value on cardiac function and prevention of heart failure for pacemakers patients.