CAJ | 학술논문

目的探讨右心室中位间隔面及心尖部起搏下组织运动瓣环位移(TMAD)及N末端B型利钠肽(NT-proBNP)水平与患者预后的关系.方法 2009年3月至2012年1月植入DDD起搏器老年患者148例为研究对象,选择右心室中位间隔部起搏患者(RVMSP组)56例、右心室心尖部起搏患者(RVAP组)42例,观察2组患者术前、术后6、18个月心电图QRS时限,采用TMAD技术检测二尖瓣环六个位点二尖瓣环位移(MADseg)、整体位移(MADglobal),采用M型超声检测左心室收缩期同步性指标TAS-POST以及双平面法测量左心室射血分数(LVEF),实验室检查NT-proBNP、测量左心室舒张末期容积(LVEDV)以及出现心血管事件包括心室高频事件(VHR)等指标.结果所有患者均顺利完成手术,按期随访.2组心血管事件发生率比较,RVAP组最高(P＜0.05),2组VHR差异无统计学意义(P＞0.05);与术前比较,RVMSP组患者术后6、18个月NT-proBNP、LVEF、LVEDV等均无变化,RVAP组NT-proB-NP、LVEF、LVEDV无变化,二尖瓣环各位点MAD以及二尖瓣环MADgloba降低,TAS-POST增加(P＜0.05).术后18个月RVAP组NT-proBNP增加,LVEDV值增加(P＜0.05),差异有统计学意义(P＜0.05),LVEF无变化.结论 RVMSP心血管事件发生率较低,不影响患者心功能,为较理想起搏部位,TMAD可早期监测心功能受损,为起搏器患者早期心功能异常的检测提供新的方法.
목적 탐토우심실중위간격면급심첨부기박하조직운동판배위이(TMAD)급N말단B형리납태(NT-proBNP)수평여환자예후적관계.방법 2009년3월지2012년1월식입DDD기박기노년환자148례위연구대상,선택우심실중위간격부기박환자(RVMSP조)56례、우심실심첨부기박환자(RVAP조)42례,관찰2조환자술전、술후6、18개월심전도QRS시한,채용TMAD기술검측이첨판배륙개위점이첨판배위이(MADseg)、정체위이(MADglobal),채용M형초성검측좌심실수축기동보성지표TAS-POST이급쌍평면법측량좌심실사혈분수(LVEF),실험실검사NT-proBNP、측량좌심실서장말기용적(LVEDV)이급출현심혈관사건포괄심실고빈사건(VHR)등지표.결과 소유환자균순리완성수술,안기수방.2조심혈관사건발생솔비교,RVAP조최고(P＜0.05),2조VHR차이무통계학의의(P＞0.05);여술전비교,RVMSP조환자술후6、18개월NT-proBNP、LVEF、LVEDV등균무변화,RVAP조NT-proB-NP、LVEF、LVEDV무변화,이첨판배각위점MAD이급이첨판배MADgloba강저,TAS-POST증가(P＜0.05).술후18개월RVAP조NT-proBNP증가,LVEDV치증가(P＜0.05),차이유통계학의의(P＜0.05),LVEF무변화.결론 RVMSP심혈관사건발생솔교저,불영향환자심공능,위교이상기박부위,TMAD가조기감측심공능수손,위기박기환자조기심공능이상적검측제공신적방법.
Objective To evaluate the disc ring displacement tissue mitral annular displacement (TMAD) and N terminal b-type natriuretic peptide (NT-proBNP)changes and its meanings in elderly patients with dual chamber pacemaker at different ventricular pacing sites.Methods One hundred and forty-eight eld-erly patients with implanted with DDD pacemaker were enrolled in this study,56 cases with the right ventricle median interval pacing(group RVMSP)42 cases with right ventricular apex pacing(RVAP).QRS duration,the mitral valve ring six sites TMAD left ventricular ejection fraction (LVEF),NT-proBNP the left ventricular enddiastolic volume (LVEDV)and high frequency incident cardiovascular events,including ventricular index (VHR) were evaluated at preoperative and 6 and 18 months postoperative.Results All patients were successfully completed surgery,timely followed-up.The cardiovascular events were highest RVAP group(P＜0.05),there was no difference in VHR(P＞0.05).Compared with preoperative,the NT-proBNP,LVEF,LVEDV had no change in RVMSP group after 6 months and 18 months.NT-proBNP LVEF,LVEDV had no change in RVAP group,while mitral valve ring MAD and mitral valve ring MADgloba were reduced,and the TAS-POST was increased(P＜0.05).After 18 months RVAP NT-proBNP and LVEDV value increased(P＜0.05),and LVEF had no change.Conclusion In right ventricular interval pacing had a lower incidence of cardiovascular events,do not affect patients' cardiac function.TMAD indicates an early sign for cardiac function impairment