青年频发右室流出道室性早搏对左室舒张功能的影响

Effect of frequent right ventricular outflow tract premature ventricular contractions on left ventricular diastolic function in young patients

目的研究青年频发右室流出道室性早搏对左室舒张功能的影响。方法前瞻性选择2018—2019年于北京大学第三医院延庆医院就诊的有心悸、乏力、呼吸困难等临床症状、心脏结构及收缩功能正常、24 h动态心电图显示频发右室流出道室性早搏(≥1000次/24 h)的50例青年患者作为室性早搏组,50名青年健康受试者为对照组。静态和24 h心电图作为频发右室流出道室性早搏的诊断方法,采用超声心动图脉冲多普勒及多普勒组织成像模式测量左室舒张功能指标,并进行相关影响因素与多普勒指标间的相关性分析,采用logistic逐步回归分析筛选出影响左室舒张功能的危险因素。结果与对照组比较,室性早搏组E峰减速时间较长[(203.2±22.9)ms比(192.4±16.1)ms,t=-2.730,P=0.008],二尖瓣环舒张早期运动峰值速度(Ea)较低[(10.3±2.8)cm/s比(11.9±2.9)cm/s,t=0.748,P=0.010],二尖瓣环舒张早期血流峰值速度(E)与Ea的比值(E/Ea)较高(6.6±0.8比6.0±0.4,t=-0.775,P=0.002),差异均有统计学意义;室性早搏组Ea与舒张晚期运动峰值速度(Aa)的比值(Ea/Aa)较低(1.02±0.33比1.11±0.30,t=1.466,P=0.146),但差异无统计学意义;两组间二尖瓣环收缩期运动峰值速度(Sa)未见统计学差异。相关性分析发现,24 h室性早搏总搏数与Ea(R=-0.686)和Ea/Aa(R=-0.654)呈负相关,与Aa呈正相关(R=0.431)。进一步行logistic逐步回归分析发现,频发右室流出道室性早搏[Exp(B)=2.070,P=0.002]是左室舒张功能减退的危险因素之一,即频发室性早搏患者发生左室舒张功能减退的危险是健康受试者的2.07倍。结论频发(≥1000次/24 h)的右室流出道室性早搏可导致青年左室舒张功能下降。

Objective To evaluate the effect of frequent right ventricular outflow tract premature ventricular contractions on left ventricular diastolic function in young patients.Methods Fifty young patients with heart palpitation,fatigue,dyspnea and other clinical symptoms,normal cardiac structure and systolic function,and frequent premature ventricular contractions(≥1000 beats/24 hours)in the right ventricular outflow tract were prospectively selected from Yanqing Hospital of Peking University Third Hospital from 2018 to 2019 as the premature ventricular contractions group,and 50 young healthy subjects as the control group.Static ECG and 24-hour ECG were used as diagnostic methods for frequent right ventricular outflow tract premature beats.The left ventricular diastolic function indexes were measured by echocardiography pulse Doppler and Doppler tissue imaging mode.The linear correlation analysis and logistic stepwise regression analysis were carried out to screen out the risk factors affecting left ventricular diastolic function.Results Compared with control group,the E wave deceleration time(EDT)was longer[(203.2±22.9)ms vs.(192.4±16.1)ms,t=-2.730,P=0.008],the peak velocity(Ea)of mitral annular early diastolic movement was lower[(10.3±2.8)cm/s vs.(11.9±2.9)cm/s,t=0.748,P=0.010],the ratio of early diastolic blood flow peak velocity(E)to early diastolic peak velocity(Ea)of mitral annulus was significantly higher(6.6±0.8 vs.6.0±0.4,t=-0.775,P=0.002)in premature ventricular contractions group.The ratio of early diastolic peak velocity to late diastolic peak velocity(Ea/Aa)was lower in premature ventricular contractions group than that in control group(1.02±0.33 vs.1.11±0.30,t=1.466,P=0.146),but there was no statistical difference;there was no significant difference in peak systolic velocity(Sa)between the two groups.In the correlation analysis,the total number of 24-hour premature ventricular contractions was negatively correlated with Ea(R=-0.686)and Ea/Aa(R=-0.654),but positively correlated with Aa(R=0.431).Further logistic regression analysis showed that frequent right ventricular outflow tract premature beats was one of the independent risk factors affecting left ventricular diastolic function in young people[Exp(B)=2.070,P=0.002].Conclusions Frequent premature ventricular contractions(≥1000 beats/24 hours)in right ventricular outflow tract can lead to the decline of left ventricular diastolic function in young people.