病态窦房结综合征伴房室传导延迟患者心房按需起搏与房室同步起搏模式左心功能的超声评价

Echocardiography in evaluating left ventricular function of the patients with sick sinus sydrome and atrioventricular delay on AAI and DDD pacing mode

目的运用多普勒超声心动图及组织多普勒（TDI）技术评价病态窦房结综合征（SSS）伴房室传导延迟患者分别在心房按需起搏（AAI）与房室同步起搏（DDD）模式下的心脏功能,并探讨其起搏模式的选择。方法选择植入DDD起搏器的SSS伴Ⅰ度房室传导阻滞的患者24例,分别置于AAI模式和房室间期优化的DDD模式,应用多普勒超声心动图和TDI技术评价这两种起搏模式下心脏的收缩和舒张功能。结果多普勒超声心动图评价心脏收缩功能（EF,主动脉VTI）和舒张功能（E/A）参数在AAI组和DDD组之间差异无统计学意义。TDI显示收缩峰值速度（Sm）在AAI组为（10.88±2.92）cm/s,DDD组为（9.06±2.49）cm/s;舒张早期峰值速度（Em）、舒张早期峰值速度/舒张晚期峰值速度（Em/Am）在AAI组和DDD组分别为[（9.25±2.89）cm/s对（8.37±2.31）cm/s、0.96±0.35对0.80±0.25];Tei指数在AAI组为0.56±0.12,DDD组为0.80±0.40。这些参数在两组间差异有统计学意义（P〈0.05）。结论①SSS伴房室传导延迟（PR〉200ms且〈260ms）患者采用AAI起搏模式心脏收缩和舒张功能的改善优于DDD起搏模式;②TDI技术较多普勒超声心动图能更敏感地反映心脏收缩和舒张功能的变化。

Objective To evaluate cardiac function in patients with sick sinus sydrome（SSS）and first degree atrioventricular block（AVB）,who underwent AAI mode pacing or DDD mode pacing.MethodsThis study included 24 patients[13 men and 11 women,mean age（69.75±7.38）years old] with DDD pacemaker for SSS with first degree AVB（PR interval 〉210 ms and 〈260 ms）.The cardiac systolic and diastolic function of patients was measured using Doppler echocardiography and tissue Doppler imaging（TDI）.Results There were no significant differences in the parameters of LVEF,VTI,E,A and E/A between AAI group and DDD group（P〉0.05）.The parameters of Sm,Em and Em/Am in AAI group were（10.88±2.92）cm/s,（9.25±2.89）cm/s,0.96±0.35,and those in DDD group were（9.06±2.49）cm/s,（8.37±2.31）cm/s,0.80±0.25.There were significant differences between two groups（P〈0.05）.The Tei index in AAI group was significantly different from that in DDD group [0.56±0.12 vs 0.80±0.40,P〈0.05].Conclusions The AAI mode is more effective than the DDD mode in improving systolic and diastolic function of left ventricle and TDI is more sensitive than Doppler echocardiography.