南京医科大学学报（自然科学版）2012，Vol.32Issue(7)：942-947,6.
术前自身QRS波时限是起搏依赖患者心功能下降的预测因子
Preoperative intrinsic QRS duration is a predictor of left ventricular function deterioration in patients dependent on right ventricular apical pacing
摘要
Abstract
Objective:To investigate the predictive value of intrinsic QRS duration (IQRSd) for left ventricular function deterioration in patients dependent on right ventricular apical (RVA) pacing. Methods:In this study,42 patients with third degree atrioventrieular block who underwent pacemaker implantation were included. Twenty-two patients with absolute reduction value of left ventricular ejection fraction (ALVEF)≥5% after pacing (group with ALVEF≥5%) and 20 patients with ALVEF<5% after pacing (group with ALVEF<5%) were enrolled to investigate the possible reasons or predictors for the cardiac function deterioration. The examination results of 12-lead electrocardiography and echocardiography, and clinical conditions were recorded for every patient before the implantation and during the follow-up. The cumulative pacing rate of pateints were also obtained at each follow-up visit. Results: After 77.3 months of follow-up, left ventricular ejection fraction(LVEF) decreased significantly from (64.20 ± 6.30)% to (40.60 ± 10.00)% (P < 0.001) while left atrial diameter (LAD) and left ventricular end-diastolic dimension (LVEDD) enlarged significantly in group with ALVEF≥5%[LAD: (34.77 ± 6.42)mm vs. (41.00 ± 7.45)mm;LVEDD: (49.82 ± 4.86)mm vs. (55.59 ± SM)mm;P < 0.001)]. However,the average LVEF,LAD and LVEDD levels in group with ALVEF<5% after pacing were not statistically different from those before pacing [LVEF: (65.40 ± 3.25)% vs. (64.94 ± 3.00)%;LAD: (37.40 ± 4.84)mm vs. (38.15 ± 5.83)mm;LVEDD: (48.30 ± 3.95)mm vs.(49.00 ± 3.87)mm]. Kaplan-Meier analysis revealed that LVEF diminution after pacing appeared significantly earlier in patients with IQRSd S≥ 110 ms than that in patients with IQRS<110 ms. Chi Square Test showed the rate of LVEF diminution was significantly higher in patients with IQRSd ≥110 ms than that in patients with IQRSd<110 ms (P < 0.05). COX regression analysis indicated that IQRSd ≥10 ms was the independent predictor of left ventricular systolic function decrease (P < 0.05). Conclusion:Long-term RVA pacing leads to deterioration of left ventricular systolic function and cardiac remodeling. In patients with IQRSd≥110 ms, deterioration of left ventricular systolic function occured earlier and more serious than in those with IQRSd<l 10 ms. IQRSd≥ 110 ms is the independent predictor of LVEF reduction in patients dependent on right ventricular pacing.关键词
三度房室传导阻滞/右心室心尖部起搏/自身QRS波时限/心脏重构/心功能Key words
third degree atrioventricular bloek/right ventricular apical pacing/intrinsic QRS duration/cardiac remodeling/cardiac function分类
医药卫生引用本文复制引用
刘群,吴红平,陈震,王垚,姜晓宏,侯小锋,邹建刚..术前自身QRS波时限是起搏依赖患者心功能下降的预测因子[J].南京医科大学学报（自然科学版）,2012,32(7):942-947,6.基金项目
国家自然科学基金(81170162) （81170162）
