频率适应性房室延迟单左心室起搏治疗慢性心力衰竭

发布时间：2018-06-29 23:05

本文选题：心血管疾病 + 心力衰竭　；参考：《中国循环杂志》2017年02期

【摘要】：目的:本研究应用频率适应性房室延迟功能跟踪生理性房室延迟,探索单左心室起搏实现心脏再同步化治疗(CRT)的效果。方法:入选60例心力衰竭患者,随机分为频率适应性房室延迟单左心室起搏组和标准双心室起搏组各30例,测定并比较两组术后QRS时限、左心室射血分数(LVEF)、二尖瓣反流面积(MRA)、主动脉瓣前向血流速度时间积分(AVVTI)、EA峰间距(E/A Pd)、心室间机械延迟时间(IVMD)、12节段达峰时间标准差(TS-SD12)及6分钟步行距离(6MWT)的差异,并计算单左心室起搏组5个心率段V_1导联S/R比值的标准差(R_(S/R)-SD5)以评估频率适应性房室延迟功能跟踪生理性房室延迟的准确性。结果:术后单左心室起搏组AVVTI(21.84±2.25)cm较标准双心室起搏组(20.45±2.12)cm增大(P0.05);单左心室起搏组QRS时限(137±11)ms、IVMD(64.27±12.29)ms、MRA(3.09±1.12)cm~2较标准双心室起搏组(144±11)ms、(71.39±13.64)ms及(3.73±1.19)cm~2减小(P均0.05);单左心室起搏组R_(S/R)-SD5为4.23±1.89与心功能改善(ΔLVEF,即术后最近一次随访与术前LVEF值之差)负相关(r=-0.394,P=0.031)。结论:频率适应性房室延迟单左心室起搏可实现CRT,比双心室起搏更符合生理性,效果与标准双心室起搏相似。
[Abstract]:Objective: to investigate the effect of cardiac resynchronization therapy (CRT) by using frequency adaptive atrioventricular delay function to track physiologic atrioventricular delay. Methods: sixty patients with heart failure were randomly divided into two groups: frequency adaptive atrioventricular delayed single left ventricular pacing group (30 cases) and standard biventricular pacing group (30 cases). The QRS duration was measured and compared between the two groups. The differences of left ventricular ejection fraction (LVEF), mitral regurgitation area (MRA), aortic valve forward velocity time integral (AVVTI) and EA peak spacing (E / A PD), interventricular mechanical delay time (IVMD), 12 segment peak time standard deviation (TS-SD12) and 6-minute walking distance (6MWT) were observed. The standard deviation of S / R ratio of V _ 1 leads (R _ (S / R) -SD _ 5) of 5 heart rate segments in single left ventricular pacing group was calculated to evaluate the accuracy of frequency adaptive atrioventricular delay function in tracking physiological atrioventricular delay. Results: AVVTI (21.84 卤2.25) cm in the single left ventricular pacing group was significantly higher than that in the standard biventricular pacing group (20.45 卤2.12) cm (P0.05), the QRS duration in the single left ventricular pacing group was (137 卤11) Ms IVMD (64.27 卤12.29) Ms MRA (3.09 卤1.12) cm~2 was lower than that in the standard biventricular pacing group (144 卤11) ms, (71.39 卤13.64 Ms and (3.73 卤1.19) cm~2), the RSR -SD5 in the single left ventricular pacing group was 4.23 卤1.89 and the improvement of cardiac function was 4.23 卤1.89. (螖 LVEF, the difference between the most recent follow-up and the preoperative LVEF) was negatively correlated (r = -0.394, P < 0.031). Conclusion: frequency adaptive atrioventricular delayed single left ventricular pacing can achieve CRT, which is more physiological than biventricular pacing, and the effect is similar to that of standard biventricular pacing.
【作者单位】：昆明医科大学第一附属医院心内科云南省心血管病研究所;
【基金】：国家自然科学基金(81360044) 云南省科技厅-昆明医科大学联合专项基金(2013FB133) 云南省自然科学基金(2013FZ054)
【分类号】：R541.6

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