门控断层心室显像评价右室不同部位起搏患者的同步性

Effect of different pacing sites on ventricular synchrony evaluated by gated blood pool SPECT

目的 采用平衡法门控断层心室显像（GBPS）比较右室流出道（RVOT）和右室心尖部（RVA）起搏患者的心脏收缩同步性.方法 因三度或高度房室传导阻滞植入起搏器的患者50例,其中RVOT起搏组（A组）23例,RVA起搏组（B组）27例.另取24例初次化疗前肿瘤患者为对照组（C组）,对照组经心脏超声检查证实心脏结构和功能正常,既往无心脏疾病史.3组患者均行GBPS检查,获得相角程（PS）、各壁段平均位相、各壁段平均位相标准差（SD）、室间隔与左室侧壁延迟（LV Sep-Lat Delay）、室间隔与右室延迟（LV Sep-RV Delay）和左右室延迟（LV-RV Delay）等同步性数据,采用单因素方差分析对3组患者心室同步性参数进行比较.结果 A、B组中共分析48例患者.A、B 2组的左室侧壁平均位相均高于C组,分别为（120.50±40.58）ms、（103.23±28.34）ms、（84.63±22.38）ms（F=7.72,P＜0.05）,但A、B 2组间差异无统计学意义（t=1.30,P＞0.05）.右室游离壁平均位相3组间的差异均有统计学意义（F=35.55,P＜0.01）,A组为（137.05±39.27）ms,高于B组的（100.85±23.79）ms和C组的（59.13±30.52）ms.A、B 2组的PS、SD和LV Sep-Lat Delay均高于C组,差异有统计学意义（F=41.54,P＜0.01）,PS：A组（85.73±12.00）°,B组（89.85±15.61）°与C组（58.95±9.87）° SD：A组（27.68±10.66）ms,B组（26.15±13.02）ms与C组（15.63±8.35）ms（F=8.55,P＜0.01） LV Sep-Lat Delay：A组（25.06±34.23）ms,B组（2.62±60.31）ms与C组（-23.66±31.39）ms（F=6.81,P＜0.01）,但A、B 2组间差异无统计学意义（t=0.68,0.68,1.30,P均＞0.05）.A、B、C组间LV Sep-RV Delay[（57.60±56.77）,（6.36±61.88）和（-41.89±35.78）ms]和LV-RV Delay[（47.36±42.59）,（3.08±38.81）和（-26.50±20.99）ms]差异均有统计学意义（F=20.32,25.38,P均＜0.01）.结论 不论是RVA起搏还是RVOT起搏,起搏器植入术后患者心脏均存在节段性位相增加,左室内及双室间同步性均比未植入起搏器差.

Objective To compare the effect of right ventricular outflow tract （RVOT） and right ventricular apex （RVA） pacing on ventricular systolic synchrony using gated blood pool SPECT （GBPS）.Methods A total of 50 patients implanted with pacemaker due to high degree or complete atria-ventricular block were enrolled in the study. Twenty-three patients were RVOT paced （ Group A, n = 23） and 27 were RVA paced （Group B, n=27）. Twenty-four patients with malignancy, normal echocardiographic findings and no history of cardiac diseases were scheduled for pre-chemotherapy evaluation of cardiac structure and function and were enrolled as control group （ Group C, n = 24）. All patients underwent GBPS imaging and the values of phase angle （PS）, mean phase of each wall, standard deviation （SD） of mean phase of each wall, lateral-septal motion delay of left ventricle （ LV Sep-Lat Delay）, septal-right ventricular （RV） delay of LV （ LV Sep-RV Delay） and LV-RV Delay were acquired. The parameters of ventricular systolic synchrony among the three groups were compared using one-way ANOVA. Results The mean phase of LV lateral wall in Groups A and B were significantly higher than that in Group C： Group A （120.50 ±40.58） ms Group B （103.23±28.34） ms Group C （84.63 ±22.38） ms （F=7.72, P 〈0.05）. There was no significant difference between Groups A and B （ t = 1.30, P 〉 0.05 ）. The mean phase of RV in Group A was significantly larger than those in Groups B and C： Group A （ 137.05 ± 39.27） ms, Group B （ 100.85 ± 23.79） ms,Group C （59. 13 ±30.52） ms （F=35.55, P〈0.05）. PS, SD and LV Sep-Lat Delay in Groups A and B were significantly higher than those in Group C： （85.73 ± 12.00）°vs （89.85 ± 15.61 ）°vs （58.95 ±9.87）°, （27.68±10.66） ms vs （26.15 ±13.02） ms vs （15.63 ±8.35） ms, （25.06±34.23） ms vs （2. 62 ± 60. 31 ） ms vs （ - 23.66 ± 31.39） ms, F = 41.54,8.55,6.81, all P 〈 0.01 ）, however, there was no significant difference between Groups A and B （ t = 0. 68, 0.68, 1.30, all P 〉 0.05 ）. LV Sep-RV Delay and LV-RV Delay were significantly different among the three groups （ LV Sep-RV Delay： Group A （57.60 ±56.77） ms, Group B （6.36 ±61.88） ms, Group C （ -41.89 ±35.78） ms LV-RV Delay：Group A （47.36 ±42.59） ms, Group B （ 3.08 ± 38.81 ） ms Group C （ - 26.50 ± 20.99 ） ms, F = 20. 32,25.38, both P 〈 0.01 ）. Conclusion Both RVA and RVOT pacing increase the segmental phases detected by GBPS, causing inter- and intra- ventricular asynchrony compared with patients without pacemakers.