双心室起搏与右心室起搏对充血性心力衰竭急性心功能的影响

目的最近研究提示心脏再同步治疗有效地改善了慢性心肌病心力衰竭患者心功能。本研究旨在探讨双心室和右心室起搏对心功能的相对影响。方法 15例慢性心力衰竭患者心功能Ⅲ级,左心室射血分数〈35%,QRS〉130ms和二尖瓣反流。安装心房-双心室再同步起搏器。彩色多普勒超声心动图观察心功能变化。结果急性双心室和右心室起搏并未影响左心室内径和短轴缩短率,也不影响左心室射血速度和排血量。左心室压力上升和下降峰速率无明显变化。等容收缩时间缩短（P〈0.05）,但不影响等容舒张时间。增加Z比例（P〈0.05）。缩短二尖瓣反流时间（P〈0.05）,对二尖瓣环和三尖瓣环运动幅度和峰速率无明显影响。双心室和右心室起搏之间无明显差别。结论双心室起搏改善了慢性心肌病心功能。双心室和右心室起搏无明显差别。双心室起搏是一种有前途的心脏再同步治疗方法。

Acute effect of right ventricular and biventricular pacing on cardiac function in patients with chronic heart failure

Objective Recent studies have demonstrated that cardiac resynchronization therapy（CRT） is effective to the patients with chronic heart failure.The comparative study between biventricular pacing and right ventricular pacing in such patients remains unclear and their relationship to response are currently unknown.Methods Fifteen consecutive patients scheduled for implantation of a CRT device were prospectively included if they met the following criteria：New York Heart Association class III,left ventricular ejection fraction 〈 or = 35%,QRS duration 〉 130 ms,and mitral regurgitation on color-coded Doppler imaging.Results Compared with sinous rhythm,end-diastolic and end systolic dimension were similar during right ventricle pacing and biventricular pacing.The ventricular size and shortening fraction d showed no change with right ventricular pacing or biventricular pacing.There was no significant change in the peak velocity of the aortic valve between right ventricle pacing and biventricular pacing.Compared with native activation,left ventricular ejection time and filling time did not change during right ventricle and biventricular pacing.There was no significance between right ventricular pacing and biventricular pacing.Compared with native activation,Isovolumic contraction time shortened in both right ventricular pacing and biventricular pacing（P 〈 0.05） .Isovolumic relaxation time did not changed significantly when measured as the interval between aortic closure to mitral valve openning and the onset of flow on Doppler between right ventricular and biventricular pacing.Z ratio increased in both right ventricular pacing and biventricular pacing（P 〈 0.05）,but not significant between right ventricular and biventricular pacing.Duration of mitral regurgitation decreased in both right ventricular pacing and biventricular pacing（P 〈 0.05）,especially in patients with presystolic mitral regugitaion.The ratio of ejection time to mitral regurgitation duration increased in both right ventricular pacing and biventricular pacing.Peak positive and negative first deviative of LV/LA pressuregradient did not significantly changed in both right ventricular and biventricular pacing.There was no significant difference in stroke volume and cardiac output during right ventricular pacing,compared with sinous rhythem.There was no difference between right ventricular pacing and biventricular pacing in stroke volume and cardiac output as well.There was no significant increase in the maximal amplitude and shortening rate and lengthening rate of both mitral ring and tricuspide ring motion after RV pacing and Biventricular pacing.Conclusions Biventricular and right ventricular pacing have similar effects in patients with chronic heart failure.