DTI评价完全性左束支传导阻滞患者心室除极顺序

Evaluation of Ventricular Depolarization in Patients with Complete Left Bundle Branch Block by Doppler Tissue Imaging

目的本文探讨多普勒组织成像（ＤＴＩ）技术评价完全性左束支传导阻滞（ＣＬＢＢＢ）患者心室除极的可行性。方法应用多普勒组织加速度图及脉冲频谱图检测１０例ＣＬＢＢＢ患者心室除极顺序，并与正常组（２５例）进行对照。结果①ＣＬＢＢＢ心室最早除极部位位于右室前壁心尖段，与正常组迥然不同（Ｐ＜０．０００１）；②剑下四腔切面显示ＣＬＢＢＢ心室除极顺序为：右室前壁心尖、室间隔心尖、右室前壁全部、室间隔全部、左室前侧壁心尖、左室前侧壁全部；正常人心室除极顺序则为：室间隔基中部、室间隔心尖、右室前壁心尖及左室前侧壁心尖、右室前壁全部、左室前侧壁基部。③和正常组比较，ＣＬＢＢＢ患者右室前壁电除极收缩耦联正常（Ｐ＞０．０５），而各左室壁除极明显延迟（Ｐ＜０．０００５），前间隔除极方向由心尖指向心底。结论能显示心室肌收缩顺序的ＤＴＩ技术可直观、实时、精确地反映ＣＬＢＢＢ的心室电除极状态。

Objectives To assess the feasibility of ventricular depolarization in patients with complete left bundle branch block (CLBBB)by Doppler tissue imaging (DTI).Methods To study the ventricular depolarization using DTA mode and DT PW mode along with electrocardiogram in 10 patients with CLBBB and 25 healthy volunteers.Results ①The onset of the acceleration sequences in patients with CLBBB was localized in the apical segments of RVAW,there was significant differences between normal group and CLBBB group ( P <0.0001);②The sequences of ventricular depolarization was the apex of RVAW、the apex of IVS and the whole of RVAW、the whole of the IVS、the apex of the LVALW、the whole of the LVALW in CLBBB;the middle of IVS、the apex of IVS、the apex of RVAW and the apex of LVALW、the whole of RVAW、the base of LVALW in normals(subcostal 4 chamber view);③The depolarizations of left ventricular walls in CLBBB were significantly slower than those of normals ( P <0.0005),except for RVAW( P >0.05);the direction of IVS depolarization was from the apex to the base.Conclusion The study shows DTI is available to evaluate the electrical depolarization of CLBBB. [