CAJ | 학술논문

目的本研究旨在评价右心室不同部位起搏对心脏重构的长期影响.方法连续选取2008年1月至12月在大连医科大学附属第一医院初次植入双腔起搏器(DDD)的患者138例,所有患者术前和随访时行彩色超声心动图检查.比较右心室不同部位起搏对心脏重构的影响.结果右心室心尖部起搏组(RVA组,66例)和右心室间隔部起搏组(RVS组,72例)患者分别随访了(45.3±11.3)个月和(43.5±13.8)个月.随访结束时,RVS组患者左心房内径(LAD)、左心室舒张末期内径(LVEDD)、室间隔厚度(SST)、左心室后壁厚度(LVPWST)及二、三尖瓣反流情况并不优于RVA组(P＞0.05),但RVA组右心室舒张末期内径(RVEDD)大于RVS组[(19.6±2.5)mm对(17.4±2.6)mm,P=0.04],差异有统计学意义.同起搏器植入前比,RVA组二、三尖瓣反流患者例数均增加(32例对18例,38例对20例,P=0.01);RVS组二、三尖瓣反流患者例数均增加(32例对24例,30对22例,P=0.01).两组末次随访时LVEF、LVEDD、LAD、RVEDD、SST和LVPWST未发生显著改变(P＞0.05).对RVS组进一步分析发现,高、中、低位室间隔起搏亚组LVEF、LVEDD、LAD、RVEDD和LVPWST的差异无统计学意义(P＞0.05).中位室间隔起搏组SST[(9.3±1.4) mm对(10.6±1.4)mm,P=0.01]及LVPWST[(9.2±1.1)mm对(10.2±1.3)mm,P=0.02]显著小于非中位室间隔组,三尖瓣反流较非中位间隔组少(4例对14例,P=0.01);同起搏器植入前比,中位室间隔组末次随访时LAD减小[(34.9±5.2)mm对(38.3±4.9) mm,P=0.03],中位室间隔组二尖瓣反流(8例对10例,P=0.77),三尖瓣反流(4例对10例,P=0.06),均未见明显增多.结论同右心室其他部位起搏相比,中位室间隔起搏有助于降低心脏重构、减少瓣膜反流.对于左心功能正常者,RVA起搏在长期随访中并未引起明显的心功能受损.
목적 본연구지재평개우심실불동부위기박대심장중구적장기영향.방법 련속선취2008년1월지12월재대련의과대학부속제일의원초차식입쌍강기박기(DDD)적환자138례,소유환자술전화수방시행채색초성심동도검사.비교우심실불동부위기박대심장중구적영향.결과 우심실심첨부기박조(RVA조,66례)화우심실간격부기박조(RVS조,72례)환자분별수방료(45.3±11.3)개월화(43.5±13.8)개월.수방결속시,RVS조환자좌심방내경(LAD)、좌심실서장말기내경(LVEDD)、실간격후도(SST)、좌심실후벽후도(LVPWST)급이、삼첨판반류정황병불우우RVA조(P＞0.05),단RVA조우심실서장말기내경(RVEDD)대우RVS조[(19.6±2.5)mm대(17.4±2.6)mm,P=0.04],차이유통계학의의.동기박기식입전비,RVA조이、삼첨판반류환자례수균증가(32례대18례,38례대20례,P=0.01);RVS조이、삼첨판반류환자례수균증가(32례대24례,30대22례,P=0.01).량조말차수방시LVEF、LVEDD、LAD、RVEDD、SST화LVPWST미발생현저개변(P＞0.05).대RVS조진일보분석발현,고、중、저위실간격기박아조LVEF、LVEDD、LAD、RVEDD화LVPWST적차이무통계학의의(P＞0.05).중위실간격기박조SST[(9.3±1.4) mm대(10.6±1.4)mm,P=0.01]급LVPWST[(9.2±1.1)mm대(10.2±1.3)mm,P=0.02]현저소우비중위실간격조,삼첨판반류교비중위간격조소(4례대14례,P=0.01);동기박기식입전비,중위실간격조말차수방시LAD감소[(34.9±5.2)mm대(38.3±4.9) mm,P=0.03],중위실간격조이첨판반류(8례대10례,P=0.77),삼첨판반류(4례대10례,P=0.06),균미견명현증다.결론 동우심실기타부위기박상비,중위실간격기박유조우강저심장중구、감소판막반류.대우좌심공능정상자,RVA기박재장기수방중병미인기명현적심공능수손.
Objective This study aimed to investigate the impact of different right ventricular pacing sites on cardiac remodeling in a long term follow-up.Methods One hundred and thirty-eight consecutive patients with dual chamber pacemaker implantation were enrolled from January 2008 to December 2008 in The First Affiliated Hospital of Dalian Medical University.Electrocardiogram and echocardiography were performed before operation and during follow-up.Results Seventy-two patients with right ventricular septal pacing(RVS)were following up for(43.5±13.8)months,and the other 66 patients with right ventricular apical pacing(RVA)were following up for(45.3±11.3) months.The left atrial diameter (LAD),left ventricular end-diastolic diameter(LVEDD),systolic septal thickness (SST),left ventricular posterior wall systolic thickness (LVPWST),mitral regurgitation(MR) and tricuspid regurgitation(TR)were similar between the RVS and RVA group (P＞0.05),while RVA pacing was associated with larger right ventricular end-diastolic diameter[RVEDD,(19.6±2.5)mm vs.(17.4±2.6)mm,P=0.04] than RVS group when the follow-up ended.MR and TR occurred quite often both in RVA group and RVS group[RVA group MR:32 c.ases vs.18 cases,TR:38 cases vs.20 cases,P=0.01;RVS group MR:32 cases vs.24 cases,30 cases vs.22 cases,P=0.01] after implantation.There were no statistical differences in left ventricular ejection fraction (LVEF) 、LVEDD、LAD、RVEDD、SST and LVPWST before and after implantation both in RVA and RVS group.The SST [(9.3±1.4) mm vs.(10.6±1.4)mm,P=0.01]and LVPWST[(9.2±1.1)ram vs.(10.2±1.3)mm,P=0.02]in middle-RVS pacing patients were thinner than those in the non-middle-RVS pacing patients.In middle-RVS pacing patients,the LAD(P=0.03)was thinner than that befere implantation and there were no statistical differences in MR (P=0.77)and TR(P=0.06)before.Conclusion The effect of middle-RVS pacing in preventing cardiac remodeling and valve regurgitation are more obvious.LVEF does not decrease in the right ventricular apical pacing patients with normal left ventricular function before pacemaker implantation.