CAJ | 학술논문

目的评价心电图QRS间期与慢性心力衰竭(心衰)左心室同步性的关系.方法对54例慢性心衰患者(宽QnS组28例,正常QRS组26例)和15例健康人(对照组)进行心肌组织多普勒成像研究,测量收缩期和舒张早期12节段达峰时间(Ts和Te),评价不同QRS间期的慢性心衰左心室各节段不同步状况以及左心室不同步的主要影响因素.结果慢性心衰舒张末期和收缩末期容积增大,宽QRS组较正常QRS组更加显著,12节段平均Ts显著增大.以Ts≥182 ms作为分界值,正常QRS组46%、宽QRS组71%存在收缩期不同步.宽QRS组Te最大差值(Te-diff)最大,以Te-diff≥79 ms作为分界值,正常QRS组58%、宽QRS组89%存在舒张期不同步.同时存在收缩期和舒张期不同步者,正常QRS组为31%,宽QRS组为64%.收缩末期容积与左心室收缩期不同步相关,舒张末期容积与舒张期不同步相关.结论心电图QRS间期不能完全反映慢性心衰左心室同步性状况,左心室收缩末期容积和舒张末期容积直接影响左心室的收缩期和舒张期同步性.
목적 평개심전도QRS간기여만성심력쇠갈(심쇠)좌심실동보성적관계.방법 대54례만성심쇠환자(관QnS조28례,정상QRS조26례)화15례건강인(대조조)진행심기조직다보륵성상연구,측량수축기화서장조기12절단체봉시간(Ts화Te),평개불동QRS간기적만성심쇠좌심실각절단불동보상황이급좌심실불동보적주요영향인소.결과 만성심쇠서장말기화수축말기용적증대,관QRS조교정상QRS조경가현저,12절단평균Ts현저증대.이Ts≥182 ms작위분계치,정상QRS조46%、관QRS조71%존재수축기불동보.관QRS조Te최대차치(Te-diff)최대,이Te-diff≥79 ms작위분계치,정상QRS조58%、관QRS조89%존재서장기불동보.동시존재수축기화서장기불동보자,정상QRS조위31%,관QRS조위64%.수축말기용적여좌심실수축기불동보상관,서장말기용적여서장기불동보상관.결론 심전도QRS간기불능완전반영만성심쇠좌심실동보성상황,좌심실수축말기용적화서장말기용적직접영향좌심실적수축기화서장기동보성.
Objective The aim of the study is to evaluate the left ventricular(LV)dyssynchrony in chronic heart failure(HF)Patients with normal and wide QRS duration.Methods Time to peak velocity at peak systolic and early diastolic phase(Ts and Te)were determined in 12 segments of LV by echocardiography(GE Vivid 7)in 54 HF patients(28 with wide and 26 with normal QRS duration)and 15 normal controls to evaluate LV systolic and diastolic dyssynchrony.The risk factors related to LV dyssynchrony were also evaluated.Results LV end systolic and diastolic volumes were significantly larger and 12 segmental mean Ts and maximal Te difference(Te-diff)were significantly higher in HF patients with wide QRS duration tllan HF patients with normal QRS duration.Using mean Ts≥182 ms as the cut-off value,systolic dyssynchrony was present in 46% HF patients with normal QRS and 71% HF patients with wide QRS.Using Te-diff≥79 ms as the cut-off value,diastolic dyssynehrony was seen in 58% HF patients with normal QRS and 89% HF patients with wide QRS.Combined systolic and diastolic dyssynchrony was seen in 31% HF patients with normal QRS and in 64% HF patients with wide QRS.Systolic dyssynchrony Was significantly correlated to LV end systolic volume and diastolic dyssynchrony was correlated to end diastolic volume.Conclusion Percentage of LV dyssyncrony was significantly higher in HF patients with wide QRS,especially in HF patients with increased LV end systolic and diastolic volume.