实时三维超声心动图评价右心室心尖部起搏对左心室收缩同步性的早期影响

Real-time three-dimensional echocardiography observation of effects of short-term right ventricular apex pacing on left ventricular systolic synchrony

目的评价右心室心尖部起搏(RVAP)对左心室收缩同步性的早期影响。方法53例起搏器植入(均为RVAP)的患者和30位正常人,在术前及术后1个月采用实时三维超声心动图(RT3DE)检测左心室16个心肌节段达收缩末最小容积时间的差值(Tmsv16-Dif)和标准差(Tmsv16-SD)作为同步性参数,同时测量左心室射血分数(LVEF)。结果术后Tmsv16-Dif和Tmsv16-SD显著延长(P<0.001),20.75%～22.64%患者出现左心室收缩不同步,而LVEF呈减低趋势(P>0.05)。Tmsv16-Dif和Tmsv16-SD与LVEF负相关(r=-0.40和r=-0.52)。结论RVAP早期即可导致左心室收缩不同步,且其可能是收缩功能减低的主要原因。RT3DE可准确评价左心室收缩同步性。

Objective To evaluate the effects of short-term right ventricular apex pacing （RVAP） on left ventricular （LV） systolic synchrony using real-time three-dimensional echocardiography （RT3DE）. Methods Implantation of a pacemaker with right ventricle lead positioned in the apex was performed in 53 patients with sick sinus syndrome （SSS）. LV systolic synchrony and systolic function were assessed at baseline and one month after the operation by RT3DE. Results LV systolic dyssynchrony was detected in 20.75%-22. 64% patients after short-term RVAP, while LV systolic function did not changed obviously, though a tendency of impairment was observed. There was a negative correlation between LV systolic synchrony and ejection fraction. Conclusion Short-term RVAP can induce LV dyssynchrony, which is associated with im paired LV systolic function. RT3DE is a reliable technique for accurate evaluation of LV synchrony.