CAJ | 학술논문

目的：应用超声血流成像（VFM）技术评价右心室不同部位起搏患者左心室血流动力学的变化特征。方法选择2010年3月至2013年1月132例植入DDD起搏器者为研究对象，按照其起搏部位不同分为四组：右心室心尖部起搏组（RVAP组）32例、右心室高位间隔面组（RVSP1组）20例、右心室中位间隔面组（RVSP2组）44例、右心室低位间隔面组（RVSP3组）36例。4组患者分别于术前、术后18个月测量N末端B型利钠肽原（NT-proBNP）、涡流相对于二尖瓣口的横向、纵向位置及圈数、涡流半值面积（S）、涡流直径（D）、最大涡流量、涡流强度以及术后18个月心电图QRS时限等指标。结果4组中，RVSP2组QRS时限最窄。与术前比较，四组患者18个月后左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）均无显著变化（P＞0.05）； RVSP2组患者术后N末端B型利钠肽原（NT-proBNP）无显著变化（P＞0.05），而RVSP1组、RVSP3组以及RVAP组患者NT-proBNP显著增加（P＜0.05）。与术前比较，RVSP2组术后18个月组涡流圈数、最大涡流量、半径区域、涡流直径、涡流强度数值均无变化（P＞0.05），而RVSP1组及RVSP2组涡流圈数及涡流直径增大（P＜0.05），RVAP 组涡流圈数、涡流直径、涡流强度数值增加（P＜0.05）；术后18个月涡流圈数增加的3组中，以RVAP组增加最多，差异有统计学意义（P＜0.05）。结论右心室中位间隔部起搏，患者QRS时限最窄，左心室血流动力学变化不明显，为适宜起搏部位选择，VFM为评价起搏器患者术后血流变化及心功能变化提供新的检测方法。
목적：응용초성혈류성상（VFM）기술평개우심실불동부위기박환자좌심실혈류동역학적변화특정。방법선택2010년3월지2013년1월132례식입DDD기박기자위연구대상，안조기기박부위불동분위사조：우심실심첨부기박조（RVAP조）32례、우심실고위간격면조（RVSP1조）20례、우심실중위간격면조（RVSP2조）44례、우심실저위간격면조（RVSP3조）36례。4조환자분별우술전、술후18개월측량N말단B형리납태원（NT-proBNP）、와류상대우이첨판구적횡향、종향위치급권수、와류반치면적（S）、와류직경（D）、최대와류량、와류강도이급술후18개월심전도QRS시한등지표。결과4조중，RVSP2조QRS시한최착。여술전비교，사조환자18개월후좌심실사혈분수（LVEF）、좌심실서장말기용적（LVEDV）균무현저변화（P＞0.05）； RVSP2조환자술후N말단B형리납태원（NT-proBNP）무현저변화（P＞0.05），이RVSP1조、RVSP3조이급RVAP조환자NT-proBNP현저증가（P＜0.05）。여술전비교，RVSP2조술후18개월조와류권수、최대와류량、반경구역、와류직경、와류강도수치균무변화（P＞0.05），이RVSP1조급RVSP2조와류권수급와류직경증대（P＜0.05），RVAP 조와류권수、와류직경、와류강도수치증가（P＜0.05）；술후18개월와류권수증가적3조중，이RVAP조증가최다，차이유통계학의의（P＜0.05）。결론우심실중위간격부기박，환자QRS시한최착，좌심실혈류동역학변화불명현，위괄의기박부위선택，VFM위평개기박기환자술후혈류변화급심공능변화제공신적검측방법。
Objective Using the vector flow mapping (VFM) technique, we aim to evaluate the left ventricular function in patients with different right ventricular pacing site.MethodsOne hundrad and thirty-two patients accepted DDD pacemaker implantation from March 2010 to January 2013 were enrolled in the study. According to different pacing site, patients were divided into 4 groups: right ventricular apex pacing (RVAP) group with 32 patients, right ventricular high septum pacing (RVSP1) group with 20 patients, right ventricular medium septum (RVSP2) group with 44 patients and right ventricular low septum (RVSP3) group with 36 patients. QRS duration, NT-proBNP, left ventricular end-diastolic volume (LVEDV), vertical and horizontal position relative to the mitral valve and number of vortex, area (S), diameter (D), maximum flow rate (Qmax), intensity (QmaxS) of vortex were determined before and 18-month after pacemaker implantation.ResultsThe QRS duration in RVSP2 group was the narrowest, which was significantly shorter than the other 3 groups (P<0.05). No significant difference was detected between preoperative and postoperative LVEF as well as LVEDV in all 4 groups (P>0.05). The NT-proBNP level didn't significantly change postoperation in PVSP2 group (P>0.05), whereas it significantly increased in the other 3 groups (P<0.05). In RVSP2 group, number of vortex, D, S, Qmax and QmaxS didn't significantly change 18-month after operation (P>0.05), while number of vortex and D significantly increased in RVSP1 and RVSP2 group (P<0.05), and number of vortex, D and QmaxS significantly increased in RVAP group (P<0.05).ConclusionRight ventricular medium septum pacing could provide the shortest QRS duration as well as little change of left ventricular hemodynamics affection, thus could be appropriate pacing site. VFM is a novel tool for evaluating hemodynamics and ventricular function in patients with pacemaker implantation.