实时三维超声心动图评价永久起搏患者左心室收缩同步性和心功能

Evaluation on left ventricular systolic synchronicity and cardiac function in patients with permanent cardiac pacing by real-time three-dimensional echocardiography

目的探讨应用实时三维超声心动图（RT-3DE）评价永久起搏患者左心室收缩同步性和心功能。方法15例病态窦房结综合征置入双腔起搏器患者，分别将起搏模式程控为心房抑制型按需起搏（AAI）、房室按需型起搏（DDD）、心室抑制型按需起搏（VVI），每种起搏模式稳定5min后，在RT-3DE下取左心室全容积图像。应用Qlab4．2脱机分析软件，获得左心室整体与17节段容积一时间曲线和比较左心室16、12、6节段心电图QRS波起点至左心室最小容积点时间的标准差和最大时间差（即Tmsvl6．S、Tmsvl2-s、Tmsv6-s、Tmsvl6一dif、Tmsvl2-dif、Tmsv6-dif）、左心室舒张末期容积、左心室收缩末期容积、左心室射血分数、左心室舒张早期峰值充盈率、左心室17节段的舒张末期容积、收缩末期容积和节段射血分数。结果心室同步性指标容积-时间曲线和Tmsvl6-s、Tmsvl2-s、Tmsv6-s、Tmsv16．dif、Tmsv12．dif、Tmsv6-dif在AAI模式明显优于DDD、VVI模式（P〈0．05），心功能指标左心室射血分数、左心室舒张早期峰值充盈率在AAI模式下显著高于DDD和VVI模式（P〈0．05）；DDD和VVI模式的上述指标差异无统计学意义（P〉0．05）；DDD与VVI模式时左心室前间隔、下壁和后壁基底段、心尖段节段射血分数较AAI模式明显降低（P〈0．05）。结论采用RT-3DE可客观准确地评价永久起搏患者左心室收缩同步性和心功能。

Objective To determine the feasibility on the left ventricular systolic synchronicity and cardiac function evaluation in patients with permanent cardiac pacing by real-time three-dimensional echocardiography. Methods Fifteen patients with sick sinus syndrome post dual-chamber pacemaker implantation were enrolled in this study. Pacemakers were programmed to AAI, DDD, and VVI respectively. After pacing for 5 minutes in each mode, participants were examined with real-time three-dimensional echocardiography. Images in different pacing modes were obtained and analyzed by the off-line Qlab 4. 2 software. Parameters including global and 17-segmental volume-time curves （VTCs）, dispersion of time to minimal regional volume for 16, 12, and 6 left ventricular segments （Tmsvl6-s, Tmsvl2-s, Tmsv6-s） , and maximal difference of time to minimal regional volume for 16, 12 and 6 left ventricular segments （ Tmsvl6- dif, Tmsvl2-dif, Tmsv6-dif）, end diastolic volume （EDV）, end systolic volume （ESV）, left ventricular ejection fraction （LVEF）were measured respectively. Parameters of peak filling rate （PFR）, regional end diastolic volume （rEDV）, regional end systolic volume （rESV）, and regional ejection fraction （rEF） were also calculated. Results Left ventricular systolic synchronicity as reflected by VTCs, Tmsvl6-s, Tmsvl2-s, Tmsv6-s, Tmsvl6-dif, Tmsvl2-dif and Tmsv6-dif as well as parameters reflecting ventricular function, i. e. , LVEF, PFR were significantly better in AAI mode than in DDD and VVI models （ all P 〈 0.05 ）. All above indexes were similar between DDD and VVI models （ all P 〉 0. 05 ）. rEFs of left inferior wall in base, septum in base and apex were significantly lower in DDD and VVI models compared that in AAI mode （P 〈 0. 05）. Conclusion Real-time three-dimensional echocardiography can objectively and accurately evaluate left ventricular systolic synchronicity and cardiac function in patients with permanent cardiac pacing and AAI mode is superior to DDD and VVI models.