起搏依赖患者长期右心室尖起搏致起搏诱导性心肌病临床分析

Clinical study on pacing-induced cardiomyopathy resulting from long-time right ventricular apical pacing in pacemaker-dependent patients

目的:评估长期右室心尖部起搏致起搏依赖患者起搏诱导性心肌病(PiCMP)的临床情况。方法:回顾性分析近10年来本院右室心尖部起搏患者的临床资料,纳入标准为持续2年以上右室心尖部起搏依赖的患者,起搏器植入时无结构性心脏病。起搏诱导性心肌病定义为:左室射血分数(LVEF)≤45%,右室起搏时心脏运动障碍,不伴其他已知原因的心肌病。所有患者均行心脏超声检查,完成6分钟步行试验、测量血浆脑钠尿肽(BNP)水平,并让患者填写明尼苏达心功能不全生存质量调查表对患者生活质量进行评分。结果:门诊患者中有55例符合纳入标准,诊断为PiCMP 8例。超声心动图显示与正常心功能患者相比,PiCMP患者存在明显的左室重构[LVEF:(41±4)%vs.(62±6)%,P<0.05;左室舒张末期内径(LVEDD):(55±3)mm vs.(45±4)mm,P<0.05],两组患者年龄、性别、右室起搏时间、左右心室间传导延迟、QRS时限以及动脉血压均无显著差异。PiCMP患者运动能力、生活质量评分以及血浆BNP水平明显差于非PiCMP患者。结论:长期右心室尖起搏致PiCMP的发病率不高,但会严重影响患者生活质量,其形成与长期右心室尖起搏引起左室重构有密切。

AIM： To evaluate the prevalence of pacing-induced cardiomyopathy （PiCMP） resulting from long-time right ventricular apical pacing （RVAP） in pacemaker-dependent patients. METHODS： Clinical data of patients with prolonged pacing from the apex of the right ventricle were analyzed retrospectively. Inclusion criteria were right ventricular apex stimulation for at least 2 years, pacemaker dependency and absence of structural heart disease at the time of initial implantation. PiCMP was pre-defined as left ven- tricular ejection fraction （LVEF） ≤45%, dyskinesia during RV pacing and absence of other known cau- ses of cardiomyopathy. All patients were examined by echocardiography and their plasma brain natriuretic peptide （BNP） levels were detected. All patients underwent 6-min walking test （6MWT） to assess the exercise capacity and quality of life was assessed using the Minnesota Living with Heart Failure Question- naire （ MLHFQ ）. RESULTS： Fifty-five patients from our Outpatient Department met the inclusion criteria. PiCMP was diagnosed in eight patients （ 14. 5% ）. Echocardiography showed significant LV remodeling in PiCMP patients [ LVEF （41.2 ±4. 4） %, LV end-diastolic diameter （LVEDD） （ 55.3 ± 3.2） mm ] compared with that in patients with preserved LVEF [ LVEF （62. 3 ±6. 5 ） %, P 〈 0. 05, LVEDD （45.2 ± 4. 1 ） mm, P 〈 0. 05 ]. No significant differences were found in age, gender, duration of RV pacing, heart rate, interventrieular mechanical delay, QRS duration and arterial hypertension between groups. Exercise capacity, quality of life and plasma BNP level of PiCMP patients were lower than those of patients with preserved LVEF. CONCLUSION： The prevalence of PiCMP is remarkably low, but PiCMP could severely affect the quality of life. PiCMP is associated with pronounced LV remodeling resulting fi＇om RVAP.