右室起搏QRS波时限与左室功能关系的研究

The study on relationship between right ventricular paced QRS duration and left ventricular function

目的探讨右室心尖部起搏QRS波时限在左室结构及功能评价中的价值。方法入选69例右室心尖部起搏的患者。测量术后即刻、末次随访的起搏QRS(pQRS)时限及起搏器植入术前(1周内)、末次随访时超声心动图左室射血分数(LVEF)、左室舒张末内径(LVEDd)、左室收缩末内径(LVEDs)、左房内径(LAD),分析pQRS时限与心脏多普勒超声各参数的关系。结果pQRS时限与LVEF呈负相关(p<0.01),与LVEDd、LVEDs、LAD呈正相关(p<0.05～0.01)。与pQRS<185ms组比较,pQRS≥185ms组LVEF明显减低(p<0.01)、LVEDd和LVEDs明显增加(p<0.05～0.01)。与术后即刻pQRS时限比较,末次随访时pQRS时限明显延长(p<0.01);与pQRS无明显延长组比较,pQRS时限明显延长(延长≥10ms)组LVEF显著减低(p<0.05),LVEDs显著增大(p<0.05)。结论pQRS时限对右室心尖部起搏患者左室结构和功能有较好的评估价值。

Objective To find a forecasting index of left cardiac structure and function in patients with right ventricular apical pacing. Methods Sixty-nine patients were enrolled in this study,paced QRS（pQRS） duration were measured immediately after pacemaker implantation and at the last follow-up,and echocardiography indexes,such as left ventricular ejection fraction（LVEF） ,left ventricular end-diastolic dimension（LVEDd） ,left ventricular end-systolic dimension（LVEDs） ,and left atrial dimension（LAD） ,were examined at one week before pacing and at the last follow-up time. We analyzed the relationship between the pQRS duration and the structure and function of the left ventricule. Results The pQRS duration was negatively correlate with LVEF（p〈0.01） ,and positively correlated with LVEDd、LVEDs and LAD（p〈0.05～0.01） . Compared with patients whose pQRS duration〈185 ms,LVEF of patients with pQRS≥185ms descended significantly（p〈0.01） and LVEDd and LVEDs（p〈0.05～0.01） scaled up obviously. The pQRS duration prolonged obviously during the last follow-up time,comparing with immediately after pacemaker implantation（p〈0.01） . LVEF significantly decreased in patients with pQRS duration prolonged more than 10ms during follow-up（p〈0.05） and the LVEDs expanded obviously（p〈0.05） . Conclusion Paced-QRS duration is a useful index to evaluate the cardiac structures and function of left ventricle.