emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2023.7.1.1768emcardio-70Research ArticleОригинальные научные публикацииOriginal Scientific ResearchПродольная деформация миокарда левого желудочка и диссинхрония у пациентов с желудочковой электрокардиостимуляцией в отдаленном послеоперационном периодеLEft ventricular myocardial longitudinal strain and dyssynchrony in patients with ventricular pacing in the long-term postoperative periodГариповА. С.HarypauA.

Минск

Minsk

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

Минск

Minsk

mv-fraction@tut.byГУ «Республиканский научно-практический центр детской хирургии»Republican Scientific and Practical Center of Pediatric SurgeryГУО «Белорусская медицинская академия последипломного образования»Belarusian Medical Academy of Postgraduate Education2023200620257117681775Copyright © 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/70

Цель. Изучить параметры продольной деформации миокарда левого желудочка и диссинхронии у молодых пациентов с желудочковой электрокардиостимуляцией в отдаленном послеоперационном периоде.Материалы и методы. В исследование включены 60 пациентов в возрасте от 18 до 35 лет: первую группу составили 30 человек (17 мужчин и 13 женщин) с постоянными электрокардиостимуляторами (ЭКС), имплантированными после хирургической коррекции врожденного порока сердца (ВПС) по поводу возникшей послеоперационной атриовентрикулярной блокады (АВ-блокады). Вторую группу – 30 пациентов (18 мужчин и 12 женщин) с нехирургической АВ-блокадой, потребовавшей имплантации постоянного ЭКС. Всем пациентам выполнена эхокардиография с определением продольной деформации миокарда левого желудочка (ЛЖ) и диссинхронии.Результаты. В исследуемых группах получены значимые различия в показателях региональной и общей глобальной (global longitudinal strain, GLS) продольной деформации миокарда ЛЖ. Значение деформации в апикальной двухкамерной позиции (АР2) составляет в 1-й группе –16,1 (–17,0; –10,9)%, во 2–й –18,3 (–20,1; –15,0)% (U = 287,0, р = 0,016), в трехкамерной позиции (АР3) –15,2 (–17,7; –11,8)% и 18,3 (–20,1; –17,2)% соответственно (U = 258,5, р = 0,004), в четырехкамерной позиции (АР4) –14,8 (–17,6; –11,8)% и –17,1 (–18,4; –15,5)% соответственно (U = 189,5, p = 0,000). GLS в исследуемых группах составил –15,4 (–16,8; –12,3)% и –17,9 (–19,0; –16,5)% соответственно (U = 193,5, р = 0,000). Удельный вес лиц с GLS более –16% в группе пациентов с ЭКС, имплантированными после хирургической коррекции ВПС составил 57%, что значимо выше, чем в группе с ЭКС, установленными по причине нехирургической АВ-блокады, – 23% (χ2 = 6,94, p = 0,008). Межжелудочковая механическая задержка в группах значимо не отличалась и составила 40,5 (15,0; 54,5) мс и 28,5 (7,0; 53,0) мс соответственно (U = 343,5, р = 0,236). Внутрижелудочковая диссинхрония была более выражена в 1-й группе и составила 121,0 (99,0; 140,0) мс; во 2-й группе – 84,0 (63,0; 106,0) мс (U = 192,0, р = 0,000). Ширина комплекса QRS больше у пациентов 1-й группы в сравнении со значением показателя 2-й группы и составила 140 (140; 160) мс и 140 (130; 140) мс соответственно (U = 302,0, р = 0,028).Заключение. У пациентов с длительной желудочковой стимуляцией после хирургической коррекции ВПС в сравнении с пациентами с нехирургической АВ-блокадой выявлены значимо более низкие показатели общего и регионального продольного стрейна, а также более выраженные показатели диссинхронии, что свидетельствует о наличии систолической дисфункции миокарда и ремоделировании ЛЖ у данного контингента и позволяет предполагать о повышенных рисках развития ЭКС-индуцированной кардиомиопатии (ЭИКМП).

Purpose. To study the parameters of longitudinal strain of the left ventricular myocardium and dyssynchrony in young patients with ventricular pacing in the long-term postoperative period.Materials and methods. The study included 60 patients aged 18 to 35 with pacemakers. The first group consisted of 30 patients (17 men and 13 women) with permanent pacemakers implanted after surgical correction of congenital heart defect (CHD) due to postoperative atrioventricular block (AV block). The second group included 30 patients (18 men and 12 women) with non-surgical AV block who required the implantation of a permanent pacemaker. All patients underwent echocardiography to determine the longitudinal strain of the left ventricular (LV) myocardium and assess dyssynchrony.Results. Significant differences were found in the study groups regar- ding regional and total global longitudinal strain (GLS) of the LV myocardium. In group 1, the strain in the apical dual–chamber position (AP2) was –16.1 (–17.0; –10.9)% and –18.3 (–20.1; –15.0)% in the 2nd (U = 287.0, р = 0.016); in the apical three–chamber position (AP3) –15.2 (–17.7; –11.8)% and 18.3 (–20.1; –17.2)%, respectively (U = 258,5, p = 0.004); in the apical four–chamber position (AP4) –14.8 (–17.6; –11.8)% and –17.1 (–18.4; –15.5)%, respectively (U = 189.5, p = 0.000). GLS in the study groups was –15.4 (–16.8; –12.3)% and –17.9 (–19.0; –16.5)%, respectively (U = 193.5, p = 0.000). The share of patients with GLS over –16% in group 1 after CHD surgical correction was 57%, which is significantly higher than in the group with non–surgical AV block (23%) (χ2 = 6.94, p = 0.008). Interventricular mechanical delay did not differ significantly between the groups, with values of 40.5 (15.0; 54.5) ms and 28.5 (7.0; 53.0) ms, respectively (U = 343.5, p = 0.236). Intraventricular dyssynchrony was more pronounced in group 1 and totaled 121.0 (99.0; 140.0) ms compared to 84.0 (63.0; 106.0) ms in group 2 (U = 192.0, p = 0.000). The width of the QRS complex was significantly greater in group 1 compared to group 2, with values of 140 (140; 160) ms and 140 (130; 140) ms, respectively (U = 302.0, p = 0.028).Conclusion. We found that patients with prolonged ventricular pacing after CHD surgical correction, compared with patients with non-surgical AV block, have significantly lower values of total and regional longitudinal strain, as well as more pronounced dyssynchrony, which indicates the presence of systolic myocardial dysfunction and LV remodeling in this population and suggests an increased risk of developing pacemaker-induced cardiomyopathy (PICM).

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