不同起源频发室性早搏患者射频消融术后左心房功能及结构变化临床研究

Clinical study on left atrial function and structure changes in patients with frequent premature ventricular contractions of different origins after RFCA

目的:研究不同起源频发室性早搏(PVC)患者射频消融术(RFCA)术后左心房功能及结构变化。方法:选取频发PVC患者105例和同期体检正常者50例(对照组)作为研究对象,根据频发PVC患者的起源分为右心室组71例和左心室组34例。记录三组对象左心房功能及结构情况,所有PVC患者均进行RFCA术,比较右心室组和左心室组患者治疗前后左心房功能及结构变化情况及血浆中脑钠肽(BNP)水平变化情况。结果:右心室组和左心室组患者的左心房内径(LAD)、左心室内径(LVD)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左心室后壁厚度(LVPWD)、左心房收缩期左心房应变率(SRa)均显著高于对照组(P<0.05),左心室每搏输出量(LVSV)、左心房射血分数(LAEF)、左心室射血分数(LVEF)显著低于对照组(P<0.05);与RFCA术前相比,右心室组患者LAD、LAEF、左心房应变(S)、SRa、左心室收缩期左心房应变率(SRs)等指标改善情况均优于左心室组,差异有统计学意义(P<0.05);右心室组和左心室组患者血浆BNP水平均显著高于对照组,RFCA术后水平明显降低,且右心室组患者降低更显著,差异具有统计学意义(P<0.05)。结论:不同起源的频发PVC都伴随有左心房功能损伤且血浆中BNP水平升高,经过RFCA术治疗后,右心室起源PVC患者的左心房功能、结构及血浆中BNP水平改善均优于左心室起源PVC患者。

Objective:To study left atrial function and structure changes in patients with frequent premature ventricular contractions(PVC) of different origins after rediofrequency catheter ablation(RFCA).Methods:105 patients with frequent PVC and 50 patients with normal physical examination(control group) were selected as study subjects.Examination(control group) in the same period were enrolled.According to origins of frequent PVC patients,they were divided into right ventricle group(71 cases) and left ventricle group(34 cases).The left atrial function and structure of the three groups before treatment were recorded.All PVC patients underwent RFCA.The changes in left atrial function and structure,and level of plasma brain natriuretic peptide(BNP) before and after treatment were compared between right ventricle group and left ventricle group.Results:Left atrial diameter(LAD),left ventricular diameter(LVD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular posterior wall depth(LVPWD) and left atrial strain rate during systolic period(SRa) in right ventricle group and left ventricle group were significantly higher than those in control group(P<0.05),while left ventricular stroke volume(LVSV),left atrial ejection fraction(LAEF) and left ventricular ejection fraction( LVEF) were significantly lower than those in control group(P<0.05).Compared with those before RFCA,improvement in indexes such as LAD,LAEF,left atrial strain(S),SRa and left atrial strain rate during left ventricular systolic period(SRs) in right ventricle group was better than that in left ventricle group(P<0.05).The plasma BNP level in right ventricle group and left ventricle group was significantly higher than that in control group.AfterRFCA,this level was significantly decreased.And the decrease degree in right ventricle group was more significant(P<0.05).Conclusion:Frequent PVC of different origins are accompanied with left atrial dysfunction and elevated plasma BNP level.After RFCA,the improvement of left atrial function,structure and plasma BNP level in PVC patients of right ventricular origin is better than of left ventricular origin.