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目的探讨长期右室心尖起搏患者的起搏QRS时限与左心结构、左心室收缩功能及心室间不同步的关系。方法长期右室心尖部起搏患者共105例,通过常规体表心电图测得起搏QRS(pQRS)时限,运用常规心脏超声心动图检测主动脉根部内径(AO)、左房内径(LAD)、收缩末期左心室内径(LVDs)、舒张末期左心室内径(LVDd)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及左室射血分数(LVEF),分析pQRS时限与以上各心超指标的关系。结果 pQRS时限与LVDd、LVDs及IVST呈正相关(r分别为0.334、0.385和0.289,前两者P<0.01,后者P<0.05),与LVEF负相关(r=-0.312,P<0.05);pQRS时限与LAD的相关性更显著(r=0.595,P<0.01)。以pQRS时限≥180ms诊断左房扩大时,敏感度和特异度分别为86.49%和67.74%。结论对于长期右室心尖部起搏的患者,pQRS时限与左心大小及左心室收缩功能相关;pQRS时限延长(≥180ms),提示左心房扩大。
Objective To investigate the relationship between pacing QRS duration and left ventricular systolic function and ventricular dyssynchrony in patients with long-term right ventricular apical pacing. Methods A total of 105 patients with long-term right ventricular apex pacing were enrolled in this study. The time of pacing QRS (pQRS) was measured by routine surface electrocardiogram. The diameters of the aortic root (AO), left atrium (LAD) LVDs, LVDd, IVST, LVPWT and LVEF were measured at the end of systole. The relationship between pQRS time and the above heart Super indicator of the relationship. Results The time of pQRS was positively correlated with LVDd, LVDs and IVST (r = 0.334,0.385 and 0.289 respectively, P <0.01 for the former two and P <0.05 for the latter), and negatively correlated with LVEF (r = -0.312, P <0.05). The correlation between pQRS and LAD was more significant (r = 0.595, P <0.01). When the pQRS ≥ 180ms was used to diagnose left atrium enlargement, the sensitivity and specificity were 86.49% and 67.74% respectively. Conclusion Long-term right ventricular apical pacing in patients with pQRS time limit and left ventricular systolic function and left ventricular systolic function; pQRS extended (≥ 180ms), suggesting that the left atrium enlargement.