双腔起搏器不同房室延迟对左心房功能的影响

摘要

To investigate influence of different atrioventricular delay (AVD) pacing on left atrial function in patients with dual chamber pacemaker implanted. Methods: A total of 40 patients with dual chamber pacemaker implanted were selected and divided into normal diastolic function group (n = 20) and diastolic dysfunction group (n = 20). Real-time tri-plane strain rate imaging was used to measure left atrial mean systolic peak strain rate (SRs), mean early diastolic peak strain rate (SRe) and mean late diastolic peak strain rate (SRa) under different AVDs in two groups. Results: In normal diastolic function group, influence of different AVD pacing on left atrial function was no significance (P>0. 05). In diastolic dysfunction group: ① When AVD increased from 80ms to 250ms, SRa increased correspondingly and reached top at 200ms AVD, then it started to decrease gradually. When AVD was 150ms and 200ms, the SRa and left atrial ejection fraction (LAEF) were significantly higher than those at 80ms, 100ms and 250ms [SRa: (-2. 87 ±0.50) s-1 , (-3. 14 ±0.44) s-1 vs. (-2. 35 ±0.53) s-1, (-2. 55 ±0.52) s-1, (-2.55±0.49) s-1, LAEF: (46. 00 ± 3. 67)%, (51. 22 ± 3. 33)% vs. (37. 99 ± 3. 56)%, (39. 64 ± 3. 08)%, (43. 78±3. 83)%, P<0. 05 all]; ② When AVD was 80ms and 250ms, SRs increased and SRe decreased; SRs at 200ms was significantly lower than that of AVD at 80ms [ (3.02 ± 0. 56) s-1 vs. (3.27 ± 0. 62) s-1, P<0.05]. Con- elusion: Different atrioventricular delay has no significant effect on left atrial function in patients with normal dias-tolic function, but moderate prolongation of atrioventricular delay is good for left atrial function and improves he-modynamic in patients with pure diastolic dysfunction.%目的:探讨双腔起搏器不同房室延迟(AVD)起搏时对左心房功能的影响.方法:选择植入双腔起搏器的40例患者,分为舒张功能正常组(20例)和舒张功能不全组(20例).应用实时三平面应变率成像分别测算两组患者在不同AVD时左心房心肌在收缩期、舒张早期和舒张晚期平均峰值应变率(SRs、Sre和Sra).结果:在舒张功能正常组,不同AVD起搏对左心房功能的影响不显著(P＞0.05).在舒张功能不全组:①AVD自80ms开始增至250ms时,Sra随AVD的延长相应增大,在AVD为200ms时达到最大,达峰值后又逐渐下降,AVD为150ms、200ms时Sra和LAEF较AVD为80ms、100ms、250ms时明显升高[Sra:(-2.87±0.50)s-1、(-3.14±0.44)s-1,比(-2.35±0.53)s-1、(-2.55±0.52)s-1、(-2.55±0.49)s-1,LAEF:(46.00±3.67)％、(51.22±3.33)％比(37.99±3.56)％、(39.64±3.08)％、(43.78±3.83)％,P＜0.05];②当AVD为80ms、250ms时,SRs增大,Sre减小;AVD为200ms时SRs明显低于AVD为80ms时[(3.02±0.56)s-1比(3.27±0.62) s-1,P＜0.05].结论:不同房室延迟对舒张功能正常患者左心房功能的影响不明显,但对于单纯舒张功能不全的患者,适当延长房室延迟更有利于左心房的功能,改善血流动力学.