emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2023.7.2.1918emcardio-31Research ArticleОригинальные научные публикацииOriginal Scientific ResearchСтруктурно-функциональное состояние сердца у пациентов молодого возраста с желудочковой электрокардиостимуляцией в отдаленном послеоперационном периодеStructural and functional state of the heart in young patients with ventricular pacing in the long-term postoperative periodГариповА. С.HarypauA.

Минск

Minsk

mv-fraction@tut.byПатеюкИ. В.PatsiayukI.

Минск

Minsk

ГУ «Республиканский научно-практический центр детской хирургии»Republican Scientific and Practical Center of Pediatric SurgeryИнститут повышения квалификации и переподготовки кадров здравоохранения учреждения образования «Белорусский государственный медицинский университет»Institute of Advanced Training and Retraining of Healthcare Personnel of Educational Institution “Belarusian State Medical University”2023190620257219181927Copyright © Гарипов А.С., Патеюк И.В., 20252025Гарипов А.С., Патеюк И.В.Harypau A., Patsiayuk I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/31

Цель. Изучить структурно-функциональное состояние сердца у пациентов молодого возраста с желудочковой электрокардиостимуляцией в отдаленном послеоперационном периоде.Материалы и методы. В исследование включены 60 человек в возрасте от 18 до 35 лет (35 мужчин и 25 женщин) с АВ-блокадами, потребовавшими имплантацию постоянного электрокардиостимулятора (ЭКС). Первую группу составили 30 человек с постоянным ЭКС, имплантированным после хирургической коррекции ВПС по поводу возникшей послеоперационной АВ-блокады. Вторую группу – 30 человек с нехирургической АВ-блокадой. Всем пациентам проведено общеклиническое обследование, эхокардиография, ретроспективно изучена медицинская документация. Длительность электрокардиостимуляции в 1-й группе составила 15,6 (13,1; 18,0) лет, во 2-й группе – 15,7 (13,9; 18,5) лет. Всем пациентам обеих групп на момент исследования были имплантированы двухкамерные ЭКС. Медиана процента желудочковой стимуляции в обеих группах составила 100%.Результаты. В исследуемых группах выявлены значимые различия переднезаднего размера левого предсердия (ЛП): 36,5 (33,5; 39,5) мм и 33,5 (31,0; 36,0) мм (U = 281,0, р = 0,030), позволяющие предположить о начальных изменениях геометрии ЛП у пациентов 1-й группы. Признаки ремоделирования (концентрическая и эксцентрическая гипертрофии и концентрическое ремоделирование) ЛЖ выявлены у 40% (12 человек из 30) пациентов 1-й группы и у 10% (3 человек из 30) 2-й группы (χ2 = 7,20, p = 0,007). В 1-й группе фракция выброса (ФВ) ЛЖ в В – режиме была значимо ниже, чем во 2- группе и составила 59,0 (52,0; 63,0)% и 61,5 (56,0; 66,0) % (U = 307,5, р = 0,034) соответственно. У 40% пациентов 1-й группы и у 17% во 2-й группе выявлена ФВ ЛЖ <55% (χ2 = 4,02, p = 0,045). Диастолическую дисфункцию ЛЖ выявили у 26% человек 1-й группы, во 2-й группе пациентов с нарушением диастолической функции определено не было (F = 0,154, p = 0,005).Заключение. У пациентов с длительной желудочковой стимуляцией после хирургической коррекции ВПС выявлены значимые структурно-функциональные изменения сердца (признаки ремоделирования левых отделов сердца, систолической и диастолической дисфункции ЛЖ), что может являться значимыми предикторами неблагоприятных сердечно-сосудистых событий, в том числе сердечной недостаточности и смертности. У пациентов с нехирургической АВ-блокадой с длительной желудочковой стимуляции не было выявлено значимых нарушений функции сердца.

Aim. To study the structural and functional state of the heart in young patients with ventricular pacing in the long-term postoperative period.Materials and methods. The study included 60 people aged 18 to 35 years (35 men and 25 women) with AV blocks that required the implantation of a permanent pacemaker (PM). The first group consisted of 30 people with permanent PMs implanted after surgical correction of CHD due to postoperative AV blockage. The second group consisted of 30 people with non-surgical AV block. All patients underwent a general clinical examination, echocardiography, and medical documentation was retrospectively studied. The duration of pacing in group 1 was 15.6 (13.1; 18.0) years, in group 2 - 15.7 (13.9; 18.5) years. All patients of both groups at the time of the study were implanted with two-chamber PMs. The median percentage of ventricular stimulation in both groups was 100%.Results. In the study groups, significant differences were revealed in the anteroposterior size of the left atrium (LA): 36.5 (33.5; 39.5) mm and 33.5 (31.0; 36.0) mm (U = 281.0, p = 0.030), suggesting initial changes in LA geometry in patients of group 1. Signs of LV remodeling (concentric and eccentric hypertrophy and concentric remodeling) were detected in 40% (12 people out of 30) of patients in group 1 and in 10% (3 people out of 30) in group 2 (χ2 = 7.20, p = 0.007). In group 1, LV ejection fraction (EF) in B mode was significantly lower than in group 2 and made up 59.0 (52.0; 63.0) % and 61.5 (56.0; 66.0)% (U = 307.5, p = 0.034), respectively. 40% of patients in group 1 and 17% in group 2 had LVEF < 55% (χ2 = 4.02, p = 0.045). LV diastolic dysfunction was detected in 26% of people in group 1; in group 2, no patients with diastolic dysfunction were identified (F = 0.154, p = 0.005).Conclusion. In patients with long-term ventricular stimulation after surgical correction of congenital heart disease, significant structural and functional changes in the heart were revealed (signs of remodeling of the left heart, systolic and diastolic dysfunction of the left ventricle), which appear to be significant predictors of cardiovascular events, including heart failure and mortality. In patients with non-surgical AV block and long-term ventricular pacing no significant impairment of cardiac function was detected.

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The authors declare that there are no conflicts of interest present.