右室不同部位起搏对左房收缩功能及血脑钠肽的影响

Effect of right ventricular septum and apex pacing on left atrial systolic function and plasma brain natriuretic peptide in patients

目的:运用超声心动图(ultrasonic cardiogram,UCG)评价右室心尖部(right ventricular apical,RVA)起搏及右室间隔部(right ventricular septal,RVS)起搏对完全性房室传导阻滞患者左室、左房收缩功能的影响,并观察两组患者的血浆脑钠肽(brain natriuretic peptide,BNP)水平的变化,研究植入埋藏式心脏起搏器术后左室收缩功能与血浆BNP之间是否具有相关性。方法:将具备埋藏式心脏起搏器植入适应证的51例完全性房室传导阻滞患者随机分为RVA起搏组(RVA组,20例)和RVS起搏组(RVS组,31例),分别于术前、术后1、3、6及12个月采用二维超声心动图Simpson法测定所有患者的左室射血分数(ejection fraction of left ventricle,LVEF)及左房射血分数(ejection fraction of left atrial,LAEF),同时测定患者血浆BNP值。结果:两组LVEF术后12个月较术前、术后1个月、术后3个月有所恢复(P<0.01);两组LAEF术后6个月、12个月较术前、术后1个月、术后3个月有所恢复(P<0.01);RVS组术后6个月、12个月LAEF恢复程度优于RVA组(P<0.01);RVS组术后12个月LVEF恢复程度优于RVA组(P<0.01)。所有患者LVEF与BNP水平呈负相关(r=-0.51,P<0.05)。RVS组术后BNP水平低于RVA组(P<0.01),RVS组术前、术后BNP水平不同时间点之间有差异(P<0.01)。结论:RVS起搏较RVA起搏更有利于左室及左房射血功能恢复,可能是更为理想的右室起搏部位。血浆BNP水平与LVEF具有相关性,可在一定程度上反映心脏起搏器安置术后患者左室收缩功能的恢复情况。

Objective：To compare the effects of right ventricular apex pacing（RVA）and right ventricular septum pacing（RVS）on left ventricle and left atrial systolic function by ultrasonic cardiogram（UCG）and plasma brain natriuretic peptide（BNP）.And further to observe if there is any correlation between LVEF and BNP.Method：51subjects who were implanted permanent pacemakers were divided into two groups：RVA group（n=20）and RVS group（n=31）.In the first month,3rd month,6th month and 12 th month after pacemaker implantation,the time to measured LVEF and LAEF by Philips IE33.At the same time to get the plasma BNP levels.Result：After12 month the LVEF of two group were higher than before（P〈0.01）.After 6month the LAEF of two group were higher than before（P〈0.01）.LAEF of RVS group were significantly higher than that of RVA group（P〈0.01）.After 6 month the LAEF of RVS group were higher than that of RVA group（P〈0.01）.After 12 month the LVEF of RVS group were higher than that of RVA group（P〈0.01）.After 3 month Tmsv16-SD of two groups were significantly higher than before（P〈0.01）.The plasma BNP level correlated negatively with LVEF（r=-0.51,P〈0.01）.The BNP levels of RVA group were extremely higher than the parameters of RVS group.Conclusion：RVS pacing is closely associated with physiological pacing compared with RVA pacing.The plasma BNP level is able to offer the partial information of left atrial systolic function after pacemaker implantation.