慢性心力衰竭患者左右心室收缩同步性研究  

The research of left and right ventricular contraction synchrony in patients with chronic heart failure

作　　者：杨新娟[1] 王秉臣[2] 崔炜[2] 刘凡[2] 方风宁[2] 王建华[2] 王绵[2] 高连发[1] 王亚平[2] 

机构地区：[1]保定市人民医院心内科 [2]河北医科大学附属第二医院心内科

出　　处：《临床心血管病杂志》2003年第6期338-341,共4页Journal of Clinical Cardiology

摘　　要：目的 :观察慢性心力衰竭 (CHF)患者左右心室收缩同步性差异 ,心电图、左室几何形态、左室收缩功能的变化。探讨双室收缩差异的发生率、双室收缩不同步与左室收缩功能、左心室几何构型、二尖瓣反流的关系。方法 :选择 2 2例CHF患者 (CHF组 ) ,NYHA分级Ⅱ～Ⅲ级 ,均符合Framingham心力衰竭诊断标准 ;健康体检者 (对照组 ) 16例 ,进行心电图、超声心动图测量、平衡状放射性核素心室造影检查。获得QRS间期、P R间期、左心室几何构型收缩期及舒张期参数 (Gibson’s指数、Cole’s指数、面积长度指数 )、二尖瓣反流程度、左和右心室功能参数、全心室的相角程、半高宽。结果 :与对照组相比CHF患者的心电图 (均P <0 .0 5 )、心脏几何构型 (均P <0 .0 5 )、左室射血分数 (LVEF)明显不同 (P <0 .0 1)、位相分析参数 (P <0 .0 1)存在着明显异常 ;77%CHF患者存在着室间非同步收缩 ,这些患者具有较低的LVEF及较重的二尖瓣反流程度 ;室间非同步收缩与左心功能呈明显负相关(r =- 0 .5 5 ,P <0 .0 5 ) ,与二尖瓣反流程度呈明显正相关 (r =0 .5 6 8,P <0 .0 5 ) ,与左心室舒张期几何形态有一定的相关性 (r =0 .5 32 ,P <0 .0 5、r =0 .5 32 ,P <0 .0 5 )。结论Objective:To observe contraction desynchronization of the left and right ventricle and alterations of electrocardiography and left ventricular geometric shape in patients with chronic congestive heart failure in sinus rhythm. To explore the incidence of interventricular desynchronization in patients with chronic congestive heart failur and the correlation among biventricular contractile desynchronization, left ventricular function, left ventricular geometric shape and mitral regurgitation.Methods:Twenty-two patients in sinus rhythm with chronic congestive heart failure who fulfill the Framingham heart failure diagnostic criteria (NYHA class II～III) and sixteen control subjects were studied by standard 12-lead electrocardiography(QRS duration, P-R duration were obtained), two dimensional echocardiography(Gibson's index, Cole's index, Area length index and mitral regurgitation were computed), and gated equilibrium blood pool scintigraphy (functional parameters of Left ventricular and right ventricular, Phase angles and full width at half maximum were computed).Results:Patients with chronic heart failure had significantly abnormal electrocardiography(QRS duration, P-R duration)(P< 0.05), heart geometric shape(Cole's index, Area-length index) both at end-systole and end-diastole(P< 0.05), left ventricular systolic function(P< 0.01), and phase image(P< 0.01). Seventy-seven percent patients with heart failure had interventricular contractile desynchrony who had lower left ventricular ejection fraction and more severe mitral regurgitation compared with patients without interventricular contractile desynchrony. A significant negative correlation was found between phase angles and LVEF(r= -0.55,P< 0.05), and positive correlations were found between phase angles and mitral regurgitation(r= 0.568,P< 0.05), and Cole's index、Area-length index of left ventricle at end-diastole(r= 0.532,P< 0.05;r= 0.532,P< 0.05).Conclusion:These findings show that interventricular contractile desynchronization may result from th

关 键 词：心力衰竭 充血性 左心室功能 心电描记术 二尖瓣反流 

分 类 号：R541.6[医药卫生—心血管疾病]