右室流出道与右室心尖部起搏对心脏收缩功能和左室重构的影响

The effects of right ventricular outflow tract and right ventricular apex pacing on left ventricular systolic function and cardiac remodeling

目的评价右室流出道(RVOT)和右室心尖部(RVA)起搏对心脏收缩同步性、收缩功能和左室重构的影响。方法82例高度或III度房室传导阻滞患者随机分为RVOT起搏组(A组,n=43)和RVA起搏组(B组,n=39),以术前左室12节段达峰时间标准差(Ts-SD)是否>32.6ms对两组患者进行亚组分组,Ts-SD>32.6ms者为A1亚组与B1亚组,Ts-SD≤32.6ms为A2亚组与B2亚组。于术前及术后6个月分别进行超声心动图检查,测量舒张末左室容积(LVEDV)、收缩末左室容积(LVESV)、左室射血分数(LVEF),并采集组织多普勒图像(TDI)进行脱机分析,测量主动脉瓣射血前时间(APET)、肺动脉瓣射血前时间(PPET)、左室12节段收缩达峰时间(Ts),计算室间电机械延迟(IVMD)和Ts-SD。结果术后6个月,两组的IVMD均较术前增加;两组Ts-SD与术前比无差异。亚组分析表明术前同步性好的A2、B2亚组术后Ts-SD升高;术前同步性差的A1亚组术后Ts-SD降低。术后6个月两组LVEDV、LVESV及LVEF与术前比较均无差异,组间比较亦无差异。结论RVOT和RVA起搏短期内对左室收缩功能及左室重构均无影响,术前收缩不同步者可从RVOT起搏中获益。

Objective To evaluate the effects of right ventricular outflow tract （RVOT）and right ventricular apex （RVA） pacing on left ventricular systolic synchrony and cardiac remodeling. Methods A total of 82 patients with high degree or complete atrioventIicular block were enrolled and were randomized into two different cardiac pacing sites of RVOT （Group A, n =43 ）and RVA（ Group B, n = 39）, We diveded the two groups into four sub-groups according to whether or not Ts-SD 〉 32.6 ms, Ts-SD 〉 32.6 ms were A1 and B1 subgroup, Ts-SD ≤〈32.6 ms were A2 and B2 subgroup. 2D echocardiography was used to measure the left ventricular end diastolic volume （LVEDV） , left ventricular end systolic volume （LVESV） and left ventricular ejection fraction （LVEF） at pre-operation and after six months pacing. Meanwhile, standard deviation of the time to peak of S wave of left ventricle 12 basal and middle segments （Ts-SD） and inter ventricular mechanical delay （IVMD） were measured by tissue Doppler imaging （TDI）. Results There were no significant difference about Ts-SD between at 6 months and pre-operation. In sub-group analysis, the Ts-SD of A2, B2 subgroup in 6 months were higher than before, while the Ts-SD of A1 subgroup in 6 months were lower than before. There were no significant difference about LVEDV, LVESV and LVEF between at 6 months and pre-operation. Conclusions Patients who are asynchronized at pre-operation can benefit from RVOT pacing. But its advantage still need long time to follow - up.