组织运动瓣环位移技术评价老年双腔起搏器患者不同部位起搏与预后关系

目的 探讨右心室中位间隔面及心尖部起搏下组织运动瓣环位移（TMAD）及N末端B型利钠肽（NT-proBNP）水平与患者预后的关系.方法 2009年3月至2012年1月植入DDD起搏器老年患者148例为研究对象,选择右心室中位间隔部起搏患者（RVMSP组）56例、右心室心尖部起搏患者（RVAP组）42例,观察2组患者术前、术后6、18个月心电图QRS时限,采用TMAD技术检测二尖瓣环六个位点二尖瓣环位移（MADseg）、整体位移（MADglobal）,采用M型超声检测左心室收缩期同步性指标TAS-POST以及双平面法测量左心室射血分数（LVEF）,实验室检查NT-proBNP、测量左心室舒张末期容积（LVEDV）以及出现心血管事件包括心室高频事件（VHR）等指标.结果 所有患者均顺利完成手术,按期随访.2组心血管事件发生率比较,RVAP组最高（P＜0.05）,2组VHR差异无统计学意义（P＞0.05）;与术前比较,RVMSP组患者术后6、18个月NT-proBNP、LVEF、LVEDV等均无变化,RVAP组NT-proB-NP、LVEF、LVEDV无变化,二尖瓣环各位点MAD以及二尖瓣环MADgloba降低,TAS-POST增加（P＜0.05）.术后18个月RVAP组NT-proBNP增加,LVEDV值增加（P＜0.05）,差异有统计学意义（P＜0.05）,LVEF无变化.结论 RVMSP心血管事件发生率较低,不影响患者心功能,为较理想起搏部位,TMAD可早期监测心功能受损,为起搏器患者早期心功能异常的检测提供新的方法.

Evaluation of tissue mitral annular displacement and N terminal b-type natriuretic peptide in elderly patients with dual chamber pacemaker at different ventricular pacing sites

Objective To evaluate the disc ring displacement tissue mitral annular displacement （TMAD） and N terminal b-type natriuretic peptide （NT-proBNP）changes and its meanings in elderly patients with dual chamber pacemaker at different ventricular pacing sites.Methods One hundred and forty-eight eld-erly patients with implanted with DDD pacemaker were enrolled in this study,56 cases with the right ventricle median interval pacing（group RVMSP）42 cases with right ventricular apex pacing（RVAP）.QRS duration,the mitral valve ring six sites TMAD left ventricular ejection fraction （LVEF）,NT-proBNP the left ventricular enddiastolic volume （LVEDV）and high frequency incident cardiovascular events,including ventricular index （VHR） were evaluated at preoperative and 6 and 18 months postoperative.Results All patients were successfully completed surgery,timely followed-up.The cardiovascular events were highest RVAP group（P〈0.05）,there was no difference in VHR（P〉0.05）.Compared with preoperative,the NT-proBNP,LVEF,LVEDV had no change in RVMSP group after 6 months and 18 months.NT-proBNP LVEF,LVEDV had no change in RVAP group,while mitral valve ring MAD and mitral valve ring MADgloba were reduced,and the TAS-POST was increased（P〈0.05）.After 18 months RVAP NT-proBNP and LVEDV value increased（P〈0.05）,and LVEF had no change.Conclusion In right ventricular interval pacing had a lower incidence of cardiovascular events,do not affect patients＆#39; cardiac function.TMAD indicates an early sign for cardiac function impairment