超声心动图评价束支传导阻滞患者左右心室间收缩失同步

Evaluation of interventricular systolic dyssynchrony in patients with bundle branch block using echocardiography

目的探讨定量组织多普勒及频谱多普勒成像观察束支传导阻滞患者左右心室间心肌收缩运动失同步的应用价值。方法完全性右束支(RBBB)及完全性左束支传导阻滞者(LBBB)各20例,正常对照者20例。测量右室游离壁、室间隔、左室侧壁基底段收缩的起始(TO)、达峰(TS)及终止时间(TSe);肺动脉瓣(PETP)与主动脉瓣的射血前间期(PETA)及其时间差(PETd)。结果RBBB组的右室壁TO、TS及PETP较正常组显著延迟(P<0.001),PETd为(43±8)ms。LBBB组的室间隔和侧壁的TO、TS、TSe及PETA均较正常组显著延迟(P<0.001),PETd为(-45±22)ms。结论定量组织多普勒能够观察到心室电-机械耦联情况,结合频谱多普勒对血流动力学的测定,可以综合评价左右心室间运动的失同步。

Objective To evaluate the interventricular systolic dyssynchrony in patients with bundle branch block by tissue Doppler imaging （TDI） and pulsed-wave Doppler （PW） echocardiography. Methods Subjectswere isolated left bundle branch block （LBBB, n= 20）, isolated right bundle branch block （RBBB, n= 20）, and normal controls （n= 20）. The regional durations of time measured for the basal segments in the right ventricle, septal and LV lateral walls were from the start of QRS to the start of S wave （To）, to the peak velocity of S wave （Ts） and to the end of S wave （TSe） respectively. The difference of pre-ejection time （PETd） between aortic （PETA） and pulmonary valves （PETp） in PW was also measured. Results To, Ts of right ventricle wall and PETp were delayed in those with RBBB compared with the normal controls （P〈 0. 001）. The PETd of RBBB group was （43±8） ms. To, Ts, Ts, of septal and lateral wall and PETA were also delayed in those with LBBB （P〈0. 001）. The PETd of LBBB group was （-45±22） ms. Conclusion Combination of TDI with PW techniques can assess the electromechanical uncoupling processes and interventricular dyssynchrony in patients with bundle branch block.