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目的探讨右室心尖部起搏QRS波时限在左室结构及功能评价中的价值。方法入选69例右室心尖部起搏的患者。测量术后即刻、末次随访的起搏QRS(pQRS)时限及起搏器植入术前(1周内)、末次随访时超声心动图左室射血分数(LVEF)、左室舒张末内径(LVEDd)、左室收缩末内径(LVEDs)、左房内径(LAD),分析pQRS时限与心脏多普勒超声各参数的关系。结果pQRS时限与LVEF呈负相关(p<0.01),与LVEDd、LVEDs、LAD呈正相关(p<0.05～0.01)。与pQRS<185ms组比较,pQRS≥185ms组LVEF明显减低(p<0.01)、LVEDd和LVEDs明显增加(p<0.05～0.01)。与术后即刻pQRS时限比较,末次随访时pQRS时限明显延长(p<0.01);与pQRS无明显延长组比较,pQRS时限明显延长(延长≥10ms)组LVEF显著减低(p<0.05),LVEDs显著增大(p<0.05)。结论pQRS时限对右室心尖部起搏患者左室结构和功能有较好的评估价值。
Objective To investigate the value of right ventricular apex pacing QRS wave duration in left ventricular structure and function evaluation. Methods 69 patients with right ventricular apical pacing were enrolled. Measurements of pQRS and pQRS at the latest follow-up were performed prior to (within 1 week) the implantation of the pacemaker and at the final follow-up. Echocardiographic left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter LVEDd, LVEDs and LAD, and analyzed the relationship between pQRS duration and parameters of Doppler echocardiography. Results The pQRS duration was negatively correlated with LVEF (p <0.01) and positively correlated with LVEDd, LVEDs and LAD (p <0.05-0.01). Compared with pQRS <185ms group, LVEF in pQRS≥185ms group was significantly lower (p <0.01) and LVEDd and LVEDs were significantly increased (p <0.05 ~ 0.01). Compared with the pQRS immediately after the operation, the pQRS duration was significantly longer at the last follow-up (p <0.01). Compared with the pQRS without prolongation, the LVEF was significantly decreased (p <0.05) and the LVEDs were significantly decreased (p> 0.05) Increased (p <0.05). Conclusions The pQRS duration has a good evaluation of left ventricular structure and function in patients with right ventricular apical pacing.