二维斑点追踪成像技术评价不同起搏模式下左心室收缩功能

Evaluation of left ventricular systolic function under different pacing modes by two-dimensional speckle tracking imaging

目的利用二维斑点追踪成像技术来评价双腔起搏器植入患者在不同起搏模式下左心室收缩功能,探讨二维斑点追踪成像技术的临床应用价值。方法选取因病态窦房结综合征而植入双腔起搏器的患者35例,起搏器程控分别置于心房按需型起搏模式(AAI起搏模式),以及房室间期优化的房室全自动起搏模式(DDD起搏模式)。应用M5S探头分别采集心尖三腔、四腔及二腔切面的二维灰阶动态图,应用Echo PAC分析软件获取左心室各节段、整体纵向应变-时间曲线,计算左心室各节段以及心尖三腔(GLPS-LAX)、四腔(GLPS-A4C)、两腔(GLPS-A2C)和左心室整体(GLPS-avg)纵向应变。结果 AAI起搏模式QRS间期显著短于DDD起搏模式,差异有统计学意义(P<0.01)。两种起搏模式LAD、LVDd和LVEF等常规超声心动图参数比较,差异无统计学意义(P>0.05)。两种起搏模式GLPS_LAX、GLP_A4C、GLPS_A2C和GLPS_avg纵向应变参数比较,差异有统计学意义(P<0.01)。结论二维斑点追踪成像技术能够准确反映心脏的形变程度,可以定性、定量评价左心室收缩功能,为临床的诊断、疗效判定及随访治疗提供相关的量化参数。

Objective To assess the left ventricular function in different pacing modes by using twodimensional speckle tracking imaging（ 2 D-STI）. Methods 35 patients with dual-chamber pacemaker implantation incurred by sick sinus syndrome were involved. They all had normal cardiac function without CAD or cardiomyopathy. The pacing modes were respectively adjusted into AAI pacing mode and DDD pacing mode. After conventional measurement,pictures from apical 3-chamber,4-chamber and 2-chamber view were collected byM5 S ultrasonic probe. Global longitudinal peak systolic strain in 3-chamber,4-chamber and 2-chamber view and the average（ GLPS_ LAX,GLP_ A4C,GLPS_ A2C,GLPS_ avg） were measured by two-dimensional strain analysis software. Results There were no significant differences in routine indicators except the QRS duration（ P〈0.05）. The differences between the strain and synchronization indicators（ GLPS_LAX,GLP_A4C,GLPS_A2C,GLPS_avg） had statistical significance between the two pacing modes（ P〈0. 05）. Conclusions 2 D-STI can evaluate the left ventricular function in different pacing mode. By combining this technology,we can have qualitative and quantitative evaluation of left ventricular systolic function. It can also provide a lot of quantitative parameters for clinical diagnosis,efficacy of treatment and follow-up treatment,with great clinical value.