QRS波时限对起搏器依赖患者心脏功能的影响

A follow-up study about the influence of QRS duration on cardiac function in pacemaker-dependent patients

目的:观察右心室起搏QRS波时限对起搏器依赖患者心脏功能的影响。方法:选取在我院诊断为Ⅲ度房室传导阻滞并行永久性右心室起搏的患者112例,以起搏QRS波时限将患者分为A组(起搏QRS波时限<190ms)和B组(起搏QRS波时限≥190ms),并对每例患者进行临床评估和心脏彩色多普勒超声检查,动态随访心脏功能,以随访期间出现明显心功能下降为终点,观察起搏QRS波时限与心脏功能的关系。同时根据随访期间是否出现心功能下降将患者分为心功能下降组(Y组)和心功能无下降组(N组),并进行各因素与心功能下降之间的单因素分析,取P<0.1的因素纳入Logistic回归模型,寻找影响起搏器依赖患者心功能的因素。结果:平均随访(45.46±23.00)个月,40例(28.57%)出现明显心功能下降,其中,A组24例(27.27%),B组16例(66.67%),2组间差异有统计学意义(P=0.0004),Y组的起搏QRS波时限较N组明显延长[(176.58±22.71)∶(159.74±20.23)ms,P<0.0001]。多元Logistic逐步回归分析结果显示,左心室舒张末期内径增大、射血分数下降、左束支传导阻滞、起搏QRS波时限≥190ms、年龄及起搏时间是起搏器依赖患者心功能下降的危险因素。结论:起搏QRS波时限延长是心脏功能下降和心力衰竭发生的危险因素,可以作为起搏器依赖患者起搏后心脏功能下降的预测指标。除此之外,左心室增大、左束支传导阻滞、射血分数降低、年龄及起搏时间也是起搏器依赖患者心脏功能下降的危险因素。

Objective：To observe the influence of paced QRS duration on cardiac function in pacemaker-dependent patients.Method： 112 patients with third-degree atrioventricular block receiving right ventricular pacing were enrolled and divided into two groups based on a cut-off value of paced QRS duration 190 ms： group A（QRS190 ms） and group B（QRS≥190 ms）.Clinical assessment and cardiac Doppler ultrasound were performed at baseline and during follow-up period.The primary end point was pronounced decrease of cardiac function.Those cardiac function-influenced factors with P value less than 0.1 screened from single-factor analysis were studied by multiple logistic stepwise regression.Result：During a mean of（45.46±23.00） months,the cardiac function of 40 paients（28.57%） was decreased remarkably.And the incidence of group B was more than that of group A（66.67% vs 22.27%,P=0.0004）.The paced QRS duration of patients with cardiac function declined was longer than that of the patients without cardiac function declined（176.58±22.71 vs 159.74±20.23,P0.0001）.The result of multiple logistic stepwise regression showed that prolongation of paced QRS duration,enlargement of left ventricular,declined eject fraction,left bundle branch block,age and the time of pacing were the risk factors of decreased cardiac function in pacemaker-dependent patients.Conclusion：Prolongation of paced QRS duration is a risk factor of decreased cardiac function and heart failure,and it can predict the decline of cardiac function in pacemaker-dependent patients.As well as the paced QRS duration,enlargement of left ventricular,declined eject fraction,left bundle branch block,age and the time of pacing are the risk factors of decreased cardiac function in pacemaker-dependent patients.