右室心尖部起搏患者起搏QRS波时限与左室结构和功能关系探讨  

The diagnostic value for paced QRS duration in detecting left ventricular systolic dysfunction

作　　者：巩雪[1] 潘文志[1] 宿燕岗[1] 舒先红[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科上海市心血管病研究所,上海200032

出　　处：《中国心脏起搏与心电生理杂志》2009年第4期313-315,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金资助项目(项目编号:30671999)

摘　　要：目的评价起搏QRS波时限与左心结构和功能的关系。方法入选106例右室心尖起搏患者,分成左室射血分数(LVEF)<0.55的病例组(n=48)和LVEF>0.55的对照组(n=58)。通过常规体表心电图测得起搏QRS波时限,行超声心动图检查获取左房内径(LAD)、收缩末期左室内径(LVESD)、舒张末期左室内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及LVEF,评价患者的纽约心功能分级,同时检测患者的N端-B型利钠肽前体(NT-proBNP)水平,分析起搏QRS波时限与以上各指标的关系。结果①起搏QRS波时限与LVEDD(r=0.577,P<0.001)、LVESD(r=0.627,P<0.001)、LAD(r=0.241,P=0.013)、IVST(r=0.345,P<0.001)、LVP-WT(r=0.349,P<0.001)均呈正相关,与LVEF负相关(r=-0.570,P<0.001),与纽约心功能分级正相关(r=0.527,P<0.001),与NT-proBNP对数正相关(r=0.265,P=0.024)。②以起搏QRS波时限≥200ms诊断左室收缩功能不全,灵敏度和特异度分别为85.42%和70.69%。结论对于右室心尖部起搏的患者,起搏QRS波时限是一个简便而实用的初步判断心脏结构和功能的指标。Objective To investigate the relationships between paced QRS duration and left cardiac structures and functions. Methods Forty-eight patients with left ventricnlar（LV） systolic dysfunction [ LV eject fraction （LVEF） 〈 0. 55 ] as case group and 58 patients with LVEF≥0.55 as control group were enrolled from the patients with right ventricular apex pacing. The paced QRS duration, NT-proBNP levels and some echocardiographic parameters such as left atrial dimen- sion （LAD） , left ventricular end-systolic dimension （LVESD） , left ventricular end-diastolic dimension （LVEDD） , inter- ventricular septum thickness （ IVST）, left ventrlcular posterior wall thickness （LVPWT） and LVEF were measured. The relationships between paced QRS duration and such echocardiographic parameters, NT-proBNP and New York Heart Association（NYHA） class were studied. Results The paced QRS duration was positively correlated to LVEDD（ r = 0.577, P 〈0.001） ,LVESD（r =0.627, P 〈0.001）,LAD（r =0. 241, P=0.013）,IVST（r =0.345, P 〈0.001）,LVPWT（r =0. 349, P 〈 0.001 ）, NYHA class（ r = 0. 527, P 〈 0. 001 ）, and log（NT-proBNP） （ r = 0. 265, P = 0. 024 ）, and negatively correlated to LVEF（ r = - 0. 570, P 〈 0.001 ）. If the detecting value of left ventricular systolic dysfunction was on the basis of paced QRS duration ≥200 ms, the sensitivity and specificity were 85.42% and 70.69% , respectively. Conclusion In patients with right ventricular apex pacing, the paced QRS duration is a practical index for evaluating the left cardiac structures and left ventricular systolic function.

关 键 词：心血管病学 起搏QRS波时限 左室收缩功能不全 右室心尖部起搏 

分 类 号：R318.11[医药卫生—生物医学工程] R540.41[医药卫生—基础医学]