彩色多普勒超声检测右心室不同比例和部位起搏对老年患者心功能影响

Influence of different percentages and positions of right ventricular pacing detected by color Doppler ultrasound on heart function in elderly patients

目的通过彩色多普勒超声检测右心室不同比例及部位起搏对老年患者心功能的影响。方法选取哈尔滨医科大学附属第一医院心内科于2014年1月~2015年1月植入体内埋藏式双腔心脏起搏器的患者64例,根据术后1年起搏器程控仪上显示的右心室起搏比例将患者分为A组(≥50%)和B组(<50%)各32例,将A组分为A1(右室流出道间隔部起搏)和A2(右室心尖部起搏)两个亚组各16例。回顾性分析患者的临床资料,比较A,B两组及A1,A2两亚组术后1年左室射血分数(LVEF)、左室舒张末期内径(LVEDD)和左房内径(LAD)。应用彩色多普勒超声和x-strain软件测量并比较两亚组术后1年左室室间隔各段及左室中段室间隔各层的心肌应变率。结果 A组男性18例,女性14例,平均(78.5±5.1)岁;B组男性22例,女性10例,平均(77.1±4.9)岁。A1组共16例,平均(78.8±5.4)岁;A2组共16例,平均(78.0±5.1)岁。A,B两组术前LVEF、LVEDD和LAD差异均无统计学意义(P>0.05);与术前相比,术后1年时A组LVEF下降,LAD增加,差异均有统计学意义(P<0.05),而LVEDD无明显改变(P>0.05),B组LVEF、LVEDD和LAD均无明显改变(P>0.05);术后1年时A组LVEF低于B组,差异有统计学意义(P<0.05),两组LVEDD和LAD差异均无统计学意义(P>0.05)。A1和A2亚组术前LVEF、LVEDD和LAD差异均无统计学意义(P>0.05);与术前相比,术后1年时A1亚组LVEF、LVEDD和LAD均无明显改变(P>0.05),A2亚组LVEF下降,LVEDD和LAD增加,差异均有统计学意义(P<0.05);术后1年时A1亚组LVEF高于A2亚组,LVEDD和LAD低于A2亚组,差异均有统计学意义(P<0.05)。术后1年,A1组左室室间隔基底段和中段于收缩期、舒张早期及舒张晚期的心肌应变率高于A2组,差异均有统计学意义(P<0.05);A1组左室中段室间隔的内中外3层于收缩期、舒张早期和舒张晚期的心肌应变率高于A2组,差异均有统计学意义(P<0.05)。结论植入心脏起搏器的老年患者,与右室心尖部起搏相比,右室流出道间隔部起搏更加稳定,对左室收缩及舒张功能的影响更小。

Objective To detect the influence of different percentages and positions of right ventricular pacing on heart function detected with color Doppler ultrasound in elderly patients. Methods The patients implanted dual-chamber pacemakers (n=64) were chosen from the Department of Ultrasound of the First Affiliated Hospital of Harbin Medical University from Jan. 2014 to Jan. 2015, and then divided, according to the percentages of right ventricular pacing, into group A (≥50%) and group B (<50%, each n=32), and group A was divided further into subgroup A1 (right ventricular outflow tract septum pacing) and subgroup A2 (right ventricular apex pacing, each n=16). The patients’ clinical data was retrospectively analyzed, and left ventricular ejection fraction (LVEF), left ventricular end-diastolic inner diameter (LVEDd) and left atrial diameter (LAD) were compared between group A and group B, and between subgroup A1 and subgroup A2 after the operation for 1 y. The myocardial strain rates of all segments of left ventricular septum and all layers of medium segment of left ventricular septum were detected and compared by using color Doppler ultrasound and x-strain software after the operation for 1 y. Results There were 18 male cases and 14 female cases (average age=78.5±5.1) in group A, and 22 male cases and 10 female cases (average age=77.1±4.9) in group B. There were 16 cases (average age=78.8±5.4) in subgroup A1 and 16 cases (average age=78.0±5.1) in subgroup A2. The difference in LVEF, LVEDd and LAD had no statistical significance between group A and group B (P>0.05) before the operation. After the operation for 1 y, LVEF decreased and LAD increased (P<0.05), and LVEDd had no significant changes (P>0.05) in group A. LVEF, LVEDd and LAD had no significant changes (P>0.05) in group B. LVEF was lower in group A than that in group B (P<0.05), and difference in LVEDd and LAD had no statistical significance between 2 groups (P>0.05) after the operation for 1 y. The difference in LVEF, LVEDd and LAD had no statistical significance between subgroup A1 and subgroup A2 (P>0.05) before the operation. After the operation for 1 y, LVEF, LVEDd and LAD had no significant changes in subgroup A1 (P>0.05), and LVEF decreased and LVEDd and LAD increases in subgroup A2 (P<0.05). LVEF was higher and LVEDd and LAD were lower in subgroup A1 than those in subgroup A2 (P<0.05) after the operation for 1 y. The myocardial strain rates of left ventricular septal basal segment and medium segment at systole, early diastole and late diastole were higher in subgroup A1 than those in subgroup A2 (P<0.05) after the operation for 1 y. The myocardial strain rates of 3 layers of medium segment of left ventricular septum at systole, early diastole and late diastole were higher in subgroup A1 than those in subgroup A2 (P<0.05). Conclusion Compared with right ventricular apex pacing, right ventricular outflow tract septum pacing is more stable and has less influence on left ventricular systolic and diastolic functions in elderly patients implanted pacemakers.