Thackray Simon D R, Witte Klaus K A, Nikitin Nikolay P, Clark Andrew L, Kaye Gerald C, Cleland John G F
Castle Hill Hospital, University of Hull, Cottingham, Hull, UK.
Eur Heart J. 2003 Jun;24(12):1143-52. doi: 10.1016/s0195-668x(03)00199-4.
To assess the prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in the chronically paced population.
Three hundred and seven patients were identified from attendance at routine pacemaker follow-up clinic. Subjects underwent a medical history and examination, 6-minute walk test and echocardiography. 94 (31%) had a left ventricular ejection fraction (LVEF) <40%, of whom 83 had symptoms of heart failure (70% NYHA II, 26% NYHA III and 4% NYHA IV). Heart failure was more prevalent in patients with single chamber compared to dual chamber pacemakers, (DDD(R) 18% vs 35% VVI(R), p<0.008), and those with chronic atrial fibrillation (AF) compared to those with sinus rhythm (42% vs 21%, p=0.003). Decreasing 6-minute walk distance, history of ischaemic heart disease and years of pacing were independently associated with the presence of heart failure (combined R=0.572, p<0.001).
Heart failure due to left ventricular systolic dysfunction is common in the paced population. Only a minority of these had a pre-existing diagnosis and a smaller proportion were on 'optimal' therapy. Echocardiographic screening of this high-risk population is justified to improve rates of diagnosis and treatment of heart failure.
评估长期起搏人群中心力衰竭和无症状左心室收缩功能障碍的患病率。
从常规起搏器随访门诊就诊患者中确定307例患者。受试者接受病史采集、体格检查、6分钟步行试验和超声心动图检查。94例（31%）左心室射血分数（LVEF）<40%，其中83例有心力衰竭症状（70%为纽约心脏病协会（NYHA）II级，26%为NYHA III级，4%为NYHA IV级）。与双腔起搏器患者相比，单腔起搏器患者心力衰竭更为常见（DDD（R）型为18%，VVI（R）型为35%，p<0.008）；与窦性心律患者相比，慢性心房颤动（AF）患者心力衰竭更为常见（42%对21%，p=0.003）。6分钟步行距离缩短、缺血性心脏病病史和起搏年限与心力衰竭的存在独立相关（综合R=0.572，p<0.001）。
左心室收缩功能障碍所致心力衰竭在起搏人群中很常见。其中只有少数患者先前已确诊，接受“最佳”治疗的比例更小。对这一高危人群进行超声心动图筛查，对于提高心力衰竭的诊断和治疗率是合理的。
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