不同负荷特发性室性早搏对心脏结构和功能的影响

目的探讨不同负荷特发性室性早搏(简称室早)对心脏结构和功能的影响。方法入选102例特发性室早患者,根据室早数量与24 h总心搏的比值,将入选患者分为室早负荷<10%组(低负荷组),10%～20%组(中等负荷组),>20%组(高负荷组)。采用二维心脏超声分别测量左室射血分数(LVEF),左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD)值,并检测以上患者血清N-末端脑钠肽(NT-proBNP)水平。结果室早负荷与LVEDD(r=0.27,P=0.003)、LVESD(r=0.31,P=0.001)大小、血清NT-proBNP水平呈正相关(r=0.21,P=0.02),和LVEF呈负相关(r=0.21,P=0.02);高负荷组与低负荷组、中等负荷组相比,LVEDD、LVESD值明显增大,LVEF值明显降低(P<0.05),而NT-proBNP的升高无显著性。结论随着室早负荷的增大,左室的结构与功能出现重构性变化。

The relationship between the burden of frequent premature ventricular contractions and the cardiac structural and functional remodeling.

Objective To observe the effects of premature ventricular contractions(PVCs) burden on the remodeling of cardiac structure and function.Methods A total 102 patients with frequent PVCs who had no underlying heart disease were observed.These patients were divided into three subgroups according to the burden of PVCs: the lower burden group(<10%),the middle burden group(10% to 20%),and the higher burden group(>20%).The burden of PVCs was determined by 24-hour Holter monitoring.Left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD) and left ventricular ejection fraction(LVEF) were measured by transthoracic echocardiograph.NT-proBNP level was tested by radioimmunology.Results There was positive correlation between the burden of PVCs and LVEDD(r=0.27,P=0.003),LVESD(r=0.31,P=0.001),and the NT-proBNP level(r=0.21,P=0.02),and negative correlation between the burden of PVCs and LVEF(r=0.21,P=0.02).Compared with the lower and the middle burden group,LVEDD,LVESD in the higher burden group were significantly increased,while LVEF were decreased(P<0.05).However,there was no significant difference in the NT-proBNP levels among three groups.Conclusions The prognosis in patients with PVCs without underlying structural heart disease is considered relatively benign,attention should be paid to those with high burden PVCs.