Santos José Ferreira, Caetano Filomena, Parreira Leonor, Madeira João, Cardoso Paula, Fonseca Nuno, Segurado Filomena, Soares Luís Neves, Inês Lopes
Serviço de Cardiologia do Hospital de São Bernardo, Setúbal.
Rev Port Cardiol. 2003 Nov;22(11):1347-55.
Ventricular resynchronization therapy improves cardiac function in patients (pts) with dilated cardiomyopathy and intraventricular conduction disturbances. The effects of ventricular resynchronization on right ventricular function have been poorly studied. Tricuspid annular motion can be studied with tissue Doppler echocardiography, which enables quantitative assessment of right ventricular function. The aim of this study was to evaluate the effects of ventricular resynchronization on right ventricular function with pulsed tissue Doppler.
We studied ten pts, eight male, mean age 65 +/- 10 years, with dilated cardiomyopathy, intraventricular conduction disturbances and heart failure, New York Heart Association functional class III or IV. Five pts had coronary artery disease and the others idiopathic dilated cardiomyopathy. All pts had an implanted cardioverter-defibrillator with ventricular resynchronization.
Before and one month after device implantation right ventricular function was evaluated with pulsed wave tissue Doppler study of tricuspid annular motion. The maximum velocity of the S wave (MV-S), E wave (MV-E), and A wave (MV-A), E/A ratio, isovolumetric contraction time (IVCT) and ejection time (ET) were determined. Right ventricular size and left ventricular ejection fraction (EF) were measured. Functional class before and after implantation was assessed.
MV-S, MV-E and MV-A did not change significantly. The E/A ratio decreased significantly (p = 0.017). There were no differences in IVCT and ET, nor in right ventricular size before and after resynchronization. EF improved in all but one patient (p = 0.003). All pts had an improvement in functional class, except the one without increased EF.
Ventricular resynchronization therapy does not appear to have a deleterious effect on right ventricular function in pts with dilated cardiomyopathy and intraventricular conduction disturbances. The main beneficial effect of this type of therapy appears to be improvement in left ventricular function.
心室再同步治疗可改善扩张型心肌病合并室内传导阻滞患者的心脏功能。心室再同步对右心室功能的影响研究较少。可通过组织多普勒超声心动图研究三尖瓣环运动，从而对右心室功能进行定量评估。本研究旨在采用脉冲组织多普勒评估心室再同步对右心室功能的影响。
我们研究了10例患者，其中8例男性，平均年龄65±10岁，患有扩张型心肌病、室内传导阻滞和心力衰竭，纽约心脏协会心功能分级为III或IV级。5例患者患有冠状动脉疾病，其余为特发性扩张型心肌病。所有患者均植入了具备心室再同步功能的心脏复律除颤器。
在设备植入前及植入后1个月，通过对三尖瓣环运动进行脉冲波组织多普勒研究来评估右心室功能。测定S波最大速度（MV-S）、E波最大速度（MV-E）、A波最大速度（MV-A）、E/A比值、等容收缩时间（IVCT）和射血时间（ET）。测量右心室大小和左心室射血分数（EF）。评估植入前后的心功能分级。
MV-S、MV-E和MV-A无显著变化。E/A比值显著降低（p = 0.017）。再同步前后IVCT和ET以及右心室大小均无差异。除1例患者外，所有患者的EF均有所改善（p = 0.003）。除EF未增加的那例患者外，所有患者的心功能分级均有所改善。
对于扩张型心肌病合并室内传导阻滞的患者，心室再同步治疗似乎对右心室功能没有有害影响。这种治疗的主要有益作用似乎是改善左心室功能。
