双腔起搏器术后患者室壁运动同步性分析

Evaluation of ventricular synchrony in patients with dual chamber pacemaker by tissue doppler imaging

目的分析永久性起搏器植入术后右心室起搏患者的心室间及心室内非同步收缩的特点及影响因素。方法收集永久性起搏器植入术后的患者22例,分为右心室起搏组与对照组。应用定量组织多普勒技术获得患者左心室各节段心肌及右心室侧壁的组织多普勒速度曲线,分别测量各节段自QRS波起始至心肌收缩期峰值速度和舒张早期峰值速度的时限等收缩期同步性指标和舒张期同步性指标,以及运动速度峰值。结果右心室起搏组与对照组两组间可测得的组织多普勒参数左心室壁12个节段收缩期达峰时间[(188.3±46.0)ms比(142.6±33.3)ms]差异有统计学意义(P<0.05),表明在心室起搏组存在左心室壁收缩的延迟。但有关左心室壁12个节段内运动同步性的参数,左心室壁12个节段收缩期达峰时间的标准差[(29.9±18.7)ms比(30.3±20.3)ms]及左心室壁12个节段收缩期达峰时间最大与最小值的差值[(95.6±60.4)ms比(90.0±58.3)ms]两组间差异无统计学意义。结论常规右心室心尖起搏致QRS波增宽,可造成心室间收缩不同步,但不一定会造成左心室内收缩不同步。

Objective To investigate the interventricular and intraventricular synchronization in subjects with dual chamber pacemaker by tissue doppler imaging. Methods Twenty-two subjects with permanent pacemaker implantion were enrolled in this study. They were divided into two groups, right ventricular pacing group and no ventricular pacing group （control group）. GE Vivid 7 ultrasound system with TVI and Q analysis software was used to obtain different time parameters of synchronization. Results The time to peak velocity of 12 segments of left ventricle （LV） wall was longer in ventricular pacing group than in control group [ （ 188.3 ± 46. 0） ms vs （ 142. 6 ± 33.3 ） ms ] （ P 〈 0. 05 ）, whereas the standard deviation of the time to peak velocity of all LV segments was not larger in ventricular pacing group than in control group [（29.9± 18.7） ms vs （130. 3 ± 20. 3 ） ms]. The time difference between the latest systolic LV segment and the earliest systolic segment was also not higher in ventricular pacing group than in control group [ （95.6 ±60. 4） ms 比（90. 0 ±58.3） ms]. Conclusion There is interventricular asynchrony in patients with ventricular pacing. Ventricular pacing may cause interventricular asynchrony hut its effect on intraventricular asynchrony need further study.