超声心动图评价QRS时限对左室射血分数正常的完全性左束支传导阻滞患者右室功能的影响  

Assessment of the Effect of QRS Duration on Right Ventricular Function in Patients of Complete Left Bundle Branch Block with Preserved Left Ventricular Ejection Fraction by Echocardiography

作　　者：孔凡鑫 李光源[1] 马春燕[1] 王永槐[1] 关正宇[1] 杨军[1] Kong Fanxin;Li Guangyuan;Ma Chunyan;Wang Yonghuai;Guan Zhengyu;Yang Jun(Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China)

机构地区：[1]中国医科大学附属第一医院心血管超声科,沈阳市110001

出　　处：《中国超声医学杂志》2018年第2期145-149,共5页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金(No.81401413)

摘　　要：目的应用超声心动图评价心动图不同QRS时限对左室射血分数正常(LVEF)的完全性左束支传导阻滞(CLBBB)患者的右室功能的影响。方法选择LVEF正常的CLBBB患者50例作为病例组,并根据心电图QRS时限将病例组分为宽QRS组(QRS>150ms)和窄QRS组(120ms≤QRS≤150ms)。同期选择25例健康体检者作为对照组。应用超声心动图检测以下参数:三尖瓣环位移(TAPSE)、右室面积变化率(RVFAC)、右室整体(RV-LS-G)和游离壁整体纵向峰值应变(RV-LS-Lat)、三尖瓣舒张早期与晚期血流速度之比(Tri E/A)及三尖瓣血流与瓣环舒张早期速度之比(Tri E/e′)。结果 (1)宽QRS组及窄QRS组RV-LS-G和RV-LS-Lat均减低,且宽QRS组小于窄QRS组(P<0.05)。(2)宽QRS组及窄QRS组Tri e′均显著减小(P<0.01),但组间无显著差异(P>0.05)。(3)多重线性回归分析显示:QRS时限是RV-LSLat的主要影响因子(P<0.05)。结论 LVEF正常的CLBBB患者右室功能减低,且宽QRS组右室收缩功能小于窄QRS组。QRS时限增宽是LVEF正常的CLBBB患者右室收缩功能减低的主要危险因素。Objective To assess the effect of QRS duration on right ventricular function in patients of complete left bundle branch block with preserved left ventrieular ejection fraction using echocardiography. Methods Fifty pa tients of CLBBB with preserved LVEF were included. And based on QRS duration, these patients were divided into two groups： wide QRSgroup （QRS〉150 ms） and narrow QRSgroup （120 ms≤QRS≤150 ms）. And 25 healthy in dividuals were included as control group during the study period. Tricuspid annular plane systolic excursion （TAPSE）, right ventricular fractional area change （RVFAC）, right ventricular longitudinal peak strain of global and lateral wall （RV LS-G, RV-LS-Lat）, tricuspid early and late diastolic inflow velocity （Tri E and Tri A）, tricuspid annulus early diastolic velocity （Tri e＇）, Tri E/A and Tri E/e＇ were measured and calculated. Results （1） RV-LS-G and RV LS-Lat decreased in both wide and narrow QRS group （P〈0.05）. And RV LS-G and RV-LS Lat were lower in wide QRS group than narrow QRS group （P〈0.05）. （2） Tri e＇ was significantly decreased in both wide and narrow QRS group （P〈0.01）. However, there was no significant difference between wide and narrow QRS group. （3） QRS duration was considered as major factor of right ventricular systolic function by multiple linear regression analysis. Conclusions The right ventricular function decreased in patients of CLBBB with preserved LVEF, and patients with wide QRS duration had lower right ventricular systolic function. QRS duration was major risk factor for right ventricular systolic function.

关 键 词：超声心动图 完全性左束支传导阻滞 QRS时限 右室功能 

分 类 号：R540.45[医药卫生—心血管疾病] R541.76[医药卫生—内科学]