Topaloglu Serkan, Aras Dursun, Cagli Kumral, Yildiz Ali, Cagirci Goksel, Cay Serkan, Gunel Emre Nuri, Baser Kazim, Baysal Erkan, Boyaci Ayca, Korkmaz Sule
Department of Cardiology, Türkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Heart Vessels. 2007 Sep;22(5):328-34. doi: 10.1007/s00380-007-0978-9. Epub 2007 Sep 20.
This study was sought to examine the effects of repetitive monomorphic premature ventricular contractions (PVCs) on left ventricular (LV) diastolic function. Thirty-three symptomatic patients (Study group, 10 males, mean age 40 +/- 8 years) with normal LV systolic function and repetitive PVCs originating from the right ventricular outflow tract (RVOT-PVCs) on 24-h Holter monitoring, and 30 healthy controls (Control group, 9 males, mean age 37 +/- 9 years) were enrolled in the study. None of the patients had structural heart disease. Diastolic function was assessed by echocardiographic mitral inflow pattern and tissue Doppler imaging. The study group displayed a lower E/A ratio, longer isovolumetric relaxation time (IVRT), and longer E-wave deceleration time (EDT). In the study group 13 patients showed impaired relaxation. While mean values of the systolic velocity (Sa), early diastolic velocity (Ea), and early/late diastolic velocity (Ea/Aa) ratio were significantly lower in the study group, the Aa velocity and E/Ea ratio were significantly higher. Ea velocity was <10 cm/s in 7 study patients. Mitral inflow pattern and Ea velocity was normal in all controls. Significant correlations were found between ventricular premature beats percentage and early to late transmitral flow velocity ratio, EDT, IVRT, Ea velocity, the Ea/Aa ratio, and the E/Ea ratio. In multivariate analysis, total PVC count and age were found to be independent predictors of impaired relaxation. These results suggest that repetitive monomorphic RVOT-PVCs lead to abnormalities of LV diastolic function that may contribute to clinical symptoms in patients with structurally normal hearts.
本研究旨在探讨重复性单形性室性早搏（PVCs）对左心室（LV）舒张功能的影响。33例有症状患者（研究组，男10例，平均年龄40±8岁），左心室收缩功能正常，24小时动态心电图监测显示重复性PVCs起源于右心室流出道（RVOT-PVCs），30例健康对照者（对照组，男9例，平均年龄37±9岁）纳入本研究。所有患者均无结构性心脏病。通过超声心动图二尖瓣血流模式和组织多普勒成像评估舒张功能。研究组E/A比值较低，等容舒张时间（IVRT）较长，E波减速时间（EDT）较长。研究组中13例患者舒张功能受损。研究组的收缩期速度（Sa）、舒张早期速度（Ea）和舒张早期/晚期速度（Ea/Aa）比值的平均值显著较低，而Aa速度和E/Ea比值显著较高。7例研究患者的Ea速度<10 cm/s。所有对照组的二尖瓣血流模式和Ea速度均正常。室性早搏百分比与二尖瓣血流速度早/晚比值、EDT、IVRT、Ea速度、Ea/Aa比值和E/Ea比值之间存在显著相关性。多因素分析显示，PVC总数和年龄是舒张功能受损的独立预测因素。这些结果表明，重复性单形性RVOT-PVCs可导致左心室舒张功能异常，这可能是结构正常心脏患者出现临床症状的原因。
