实时三维超声心动图同步显像技术评价心脏再同步起搏治疗参数

Optimization of A-V and V-V Delay in CRT patients by real-time 3D echocardiography

目的:应用实时三维超声心动图三平面同步显像技术,评价扩张型心肌病行再同步起搏治疗不同起搏参数时的心肌同步性及心功能的变化。方法:采用实时三平面组织同步显像技术,同步实时获取心尖四腔观、左室心尖两腔观和左室心尖长轴观,局部心肌收缩达峰时间,采用牛眼图模式定量测量左室6个壁12个心肌节段的纵轴收缩达峰时间,测量指标为各节段的达峰时间最大延迟(Ts-max)及达峰时间标准差,同时测量左室射血分数及观察二尖瓣反流程度,观察双心室起搏前后及不同起搏参数时各指标变化。结果:双心室同步起搏后,患者心功能得到明确改善,左室射血分数从(25.3±7.6)%.提高至(39.5±13.9)%(P<0.05);左室舒张充盈时间增加,二尖瓣反流量减少;达峰时间最大延迟由术前的(434.1土215.6)ms缩短至(155.8±43.2)ms(P<0.05),达峰时间标准差由术前的(161.6土30.4)ms缩短至(63.9±21.8)ms(P<0.05);不同起搏参数时,上述各指标的改善程度不同。结论:实时三平面同步显像技术能够客观定量评价不同起搏参数下再同步化起搏治疗慢性心力衰竭的临床效果,双心室同步起搏治疗可改善心力衰竭患者的心功能,不同患者的最优起搏参数不同。

Objective： To assess the cardiac function in different AV and V-V delay in patients underwent cardiac resynchronization therapy （CRT） by reaLtime 3D （RT 3D） echocardiography. Method： The investigation included 11 patients, 8 male and 3 female, mean age of 51.2 years, with refractory chronic heart fallure and NYHA functional class in Ⅲ-Ⅳ, The mean QRS width was （143.1 ± 19.4）ms. All of the snbiects accepted biventricular synchronous pacing. Realtime 3D echocardiography was performed in each patients before and after CRT, tissue synchronization time （ts-time） and LVEF was measured. Result： After biventricular synchronous pacing, the heart function was significantly improved. The LVEF was increased from （25.3±7.6）% to （39.5±13.9）%, （P〈0.05）, The left ventricular filling time was increased and mitral regurgitation was reduced. Ts-max and TS-SD decreased from （434.1±215.6） ms and （161.6 ±30.4） ms to （155.8±43.2） ms and （63.9±21.8） ms respectively （P〈0. 05）. The results were different with different A-V and VV delay. Conclusion： The biventricular synchronous pacing can improve heart function in patients with chronic heart failure. The best A-V and VV delay were different in every patient. The RT-3D ecbocardiography can assess the CRT effect in different A-V and V-V delay.