CAJ | 학술논문

目的应用门控心肌显像观察心脏起搏器植入后早期患者左心室收缩功能与结构的变化.方法患者27例,男9例,女18例,年龄(65.1±9.5)岁.其中起搏心室感知心室R波抑制型(VVI)起搏器组15例,起搏双腔感知双腔P波或R波抑制型(DDD)起搏器组12例.采用门控心肌显像方法测定患者起搏器植入前及植入后早期[随访(4.6±1.5)个月]自身心律或起搏器工作状态下左心室功能参数值:左心室射血分数(LVEF),左心室舒张末容积(EDV),左心室收缩末容积(ESV)及左心室收缩时间.按左心室室壁活动靶心图将室壁活动度分为缺损、稀疏及正常3级.植入前后相比,有下列一项即为左心室功能重构:LVEF增加或降低10%及以上,室壁活动度改变1级及以上,左心室收缩时间延长或缩短1个时间段及以上;结构重构:EDV增加或降低10%以上.结果 (1)左心室功能重构:27例患者中,26例(96.3%;VVI组15例,DDD组11例)出现功能重构.26例中6例(23.1%;VVI组4例,DDD组2例)LVEF升高,8例(30.8%;VVI组4例,DDD组4例)LVEF降低,12例(46.2%;VVI组7例,DDD组5例)LVEF无变化.(2)结构重构:27例中13例(48.1%;VVI组10例,DDD组3例)出现结构重构.13例中4例(VVI组3例,DDD组1例)LVEF升高,3例(均为VVI组患者)LVEF降低,6例(VVI组4例,DDD组2例)LVEF无变化.结论心脏起搏器植入后早期即可发生左心室功能重构,约半数患者出现左心室结构重构.心脏永久起搏器植入在患者心脏获得电生理学益处时,可能对左心室的功能和结构带来不利影响.
목적 응용문공심기현상관찰심장기박기식입후조기환자좌심실수축공능여결구적변화.방법 환자27례,남9례,녀18례,년령(65.1±9.5)세.기중기박심실감지심실R파억제형(VVI)기박기조15례,기박쌍강감지쌍강P파혹R파억제형(DDD)기박기조12례.채용문공심기현상방법측정환자기박기식입전급식입후조기[수방(4.6±1.5)개월]자신심률혹기박기공작상태하좌심실공능삼수치:좌심실사혈분수(LVEF),좌심실서장말용적(EDV),좌심실수축말용적(ESV)급좌심실수축시간.안좌심실실벽활동파심도장실벽활동도분위결손、희소급정상3급.식입전후상비,유하렬일항즉위좌심실공능중구:LVEF증가혹강저10%급이상,실벽활동도개변1급급이상,좌심실수축시간연장혹축단1개시간단급이상;결구중구:EDV증가혹강저10%이상.결과 (1)좌심실공능중구:27례환자중,26례(96.3%;VVI조15례,DDD조11례)출현공능중구.26례중6례(23.1%;VVI조4례,DDD조2례)LVEF승고,8례(30.8%;VVI조4례,DDD조4례)LVEF강저,12례(46.2%;VVI조7례,DDD조5례)LVEF무변화.(2)결구중구:27례중13례(48.1%;VVI조10례,DDD조3례)출현결구중구.13례중4례(VVI조3례,DDD조1례)LVEF승고,3례(균위VVI조환자)LVEF강저,6례(VVI조4례,DDD조2례)LVEF무변화.결론 심장기박기식입후조기즉가발생좌심실공능중구,약반수환자출현좌심실결구중구.심장영구기박기식입재환자심장획득전생이학익처시,가능대좌심실적공능화결구대래불리영향.
Objective The aim of this study was to assess the early functional and structural changes of left ventricle (LV) after pacemaker implantation by gated SPECT (GSPECT). Methods There were 27 patients [male: 9, female: 18, age: (65.1±9.5) years] recruited into this study, 15 with VVI and 12 with DDD pacemaker. Functional parameters of LV, including ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) and systolic time, under autologous rhythm or pacemake's rhythm were evaluated by the standard GSPECT procedure before and after (4.6±1.5) months pacemaker implantation. [The Bull's-eye plot of left ventricular segmental motion was divided into 5 regions: apical, septal, lateral, inferior and anterior. A 3-point scoring system was used for severity measurement: 0=normal, 1=moderate decrease, 2=sever decrease. The functional remodeling was defined by one or more of the following criteria: more than 10% change in LVEF, more than 1 point change in wall motion score, systolic time delay or shortening. The structural remodeling was defined as more than 10% change in EDV after pacemaker implantation. Results Among 27 patients, there were 26 patients (15 with VVI pacemaker and 11 with DDD pacemaker) who showed LV functional remodeling and 13 (10 with VVI pacemaker and 3 with DDD pacemaker) showed LV structural remodeling. In autologous rhythm the LVEF did not change in 50% of patients after pacemaker implantation. Conclusion During the early period after the pacemaker implantation, functional remodeling of LV occurs in most patients and structural remodeling occurs in 50% of patients. About 50% of patients do not show any LVEF change. The results may suggest that besides the physiological benefits from the pacemaker implantation, other unfavorable functional and structural side-effects on LV must also be considered.