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目的探讨超声心动图参数评估左心室射血分数(LVEF)正常老年患者植入双腔起搏器后的左室舒张功能。方法应用斑点追踪、组织多普勒和彩色M型多普勒参数测量40例LVEF正常的植入双腔起搏器右室心尖起搏(RVAP)老年患者(A组)和30例健康体检老年人(C组)的左室收缩和舒张功能;ELISA法检测血浆B型钠尿肽(BNP)水平。随访1年。结果与C组比较,1年后,A组二尖瓣口舒张早期血流峰值/舒张晚期血流峰值、舒张早期二尖瓣环组织运动速度[室间隔侧瓣环峰值速度、外侧瓣环峰值速度及两者平均值(Ea mean)]、整体舒张早期纵向应变率和舒张早期血流播散速度均降低,而QRS波离散度、E/Ea mean和BNP升高,且等容舒张时间延长(P<0.05或P<0.01)。A组多元线性回归模型分析显示,年龄、Ea mean、E/Ea mean与BNP水平独立相关(P<0.05)。结论老年患者植入双腔起搏器后,RVAP加重了左室舒张功能的损害。Ea mean、E/Ea mean参数可作为评估左室舒张功能不全进展的重要指标。
Objective To evaluate the left ventricular diastolic function after echocardiographic parameters were evaluated in elderly patients with left ventricular ejection fraction (LVEF) implanted with double chamber pacemaker. Methods 40 patients with normal LVEF implanted RVAP elderly patients (group A) and 30 healthy volunteers were enrolled in this study. (Group C) left ventricular systolic and diastolic function; ELISA assay plasma B-type natriuretic peptide (BNP) levels. Followed up for 1 year. Results Compared with group C, after 1 year, peak early diastolic / early diastolic peak velocity, early diastolic mitral annulus velocity [the peak velocity of the lateral ventricular annulus and the peak of the lateral annulus Ea mean, mean longitudinal strain rate in early diastole and early diastolic blood flow were all decreased, while QRS dispersion, E / Ea mean and BNP increased, and isovolumetric relaxation time was prolonged (P <0.05 or P <0.01). Group A multivariate linear regression analysis showed that age, Ea mean, E / Ea mean and BNP levels independently (P <0.05). Conclusions RVAP aggravates the impairment of left ventricular diastolic function after implantation of dual chamber pacemakers in elderly patients. Ea mean, E / Ea mean parameter can be used as an important index to evaluate the progress of left ventricular diastolic dysfunction.