DDD模式起搏器植入患者二尖瓣反流的二维及实时三维超声心动图观察

Assessment of the mitral valve regurgitation in patients with implantation of DDD mode cardiac pacemakers by two-dimensional and real-time three-dimensional echocardiography

目的:探讨房室顺序双心腔起搏、感知触发和抑制型(DDD)模式起搏器植入患者二尖瓣反流(MR)的发生率及其机制。方法:应用二维及实时三维超声心动图检测20例DDD模式起搏器植入患者(病例组)和20例正常人(对照组)MR发生率、程度及左心室收缩同步性,测算MR面积与左房面积之比(MRA/LAA)、左心室舒张末期容积(VLED)、收缩末期容积(VLES)、每搏输出量(VS)、射血分数(LVEF)、17节段心电图QRS波起始点至左心室最小容积点时间的平均值(Tmean)及其标准差(T-SD)、17节段心电图QRS波起始点至左心室最小容积点时间的最大时间差(Tmax)。结果:病例组与对照组MR发生率分别为90%和36%。与对照组相比,病例组MRA/LAA、VLES增大(P<0.01),LVEF减小(P<0.05),T-SD、Tmax延长(P<0.05);2组年龄、心率、VLED、Tmean差异均无统计学意义(P>0.05);病例组中MRA/LAA与T-SD、Tmax呈正相关(r分别为0.797和0.818,P<0.05)。结论:DDD模式起搏器植入患者MR发生率明显增高,推测其发生机制可能主要与该类患者左心室收缩失同步有关。

Aim ： To assess the incidence of mitral valvular regurgitation in patients with dual-chamber （DDD） mode cardiac pacemakers implanted by two-dimensional and real-time three-dimensional echocardiography. Mothods：Mitral valvular regurgitation and left ventricular systolic synchronization were evaluated in 20 patients with DDD mode cardiac pacemakers implanted and 20 normal people by two-dimensional and real-time three-dimensional echocardiography. The ratio of the area of mitral regurgitation and the area of left atrial （MRA/LAA） , the left ventricular end-diastolic volume （ VLED ） , left ventricular end-systolic volume （ VLES） , stroke volume （ VS ） , left ventricular ejection fraction （LVEF） , the mean value of time from the start of electrocardiographic QRS wave to the point of minimal systolic volume （Tmean） of the 17 segments ）and those standard deviation （T-SD） , the maximal difference of time among all 17 segments （Tmax） were measured by two-dimefisional and real-tlme three-dimensional echocardiography. Results： The incidence of mitral regurgitation in patients group was 90% and 36% in control group. Compared with control group,MRA/LAA and VLES were significantly increased （ P 〈0. 01 ） , LVEF was significantly decreased （ P 〈 0. 05 ）, and T-SD and Tmax were significantly prolonged （ P 〈 0.05 ）. There were no differences in age, heart rate, VLED and Tmean between the two groups（P 〉0.05 ）. In patients group, MRA/ LAA was correlated closely with T-SD （ r =0. 797,P 〈 0. 05 ） and Tmax （ r = 0. 818,P 〈 0. 05 ）. Conclusion ： The incidence rate of mitral regurgitation is higher in the patients group than that in control group, which is probably caused by left ventricular systolic asynchronization.