斑点追踪技术评价右心室流出道起搏对左心室收缩同步性的影响

Evaluation on left ventricle systolic synchronization of right outflow tract pacing with speckle tracking imaging

目的应用超声二维斑点追踪技术比较右心室流出道(RVOT)及右心室心尖部(RVA)起搏对左心室收缩同步性的影响。方法将60例符合ACC/AHA起搏器植入适应证患者随机分为RVA组和RVOT组,常规将右心房电极置入右心耳处,将右心室电极分别植入RVOT间隔部及RVA。术后1周在保证心室100%起搏下进行二维斑点超声成像分析,记录左心室收缩的纵向、环向及径向应变指标。结果 RVA组左心室收缩时纵向应变(LS)及环向应变(CS)达峰时间的最大差(TD)分别为(191.07±39.24)ms、(135.92±33.40)ms;RVOT组分别为(129.18±26.20)ms、(69.78±19.10)ms。RVA组LS及CS达峰时间标准差(SD)分别为(62.90±12.63)ms、(52.62±13.58)ms;RVOT组为(41.62±5.71)ms、(28.54±7.96)ms。两组比较,LS及CS达峰时间的TD及SD的差异均有统计学意义(P均<0.001)。RVA组与RVOT组左心室收缩时径向应变(RS)达峰时间的TD分别为(105.43±58.08)ms、(42.00±21.39)ms;SD分别为(41.98±29.48)ms、(17.08±10.46)ms。两组比较,RS的TD及SD的差异均有统计学意义(P均<0.005)。结论RV-OT起搏时,左心室收缩同步性优于RVA起搏。

Objective To compare left ventricle systolic synchronization in right ventricular outflow tract （RVOT） pacing and right ventricular apical （RVA） pacing by using two-dimensional sparkle tracking imaging （STI） technology. Methods Totally 60 consecutive patients with indication of permanent pace maker implantation were randomly divided in to RVOT group and RVA group. Right atrium lead was placed in right appendage, and right ventricle lead was placed in RVOT or RVA, respectively. One week after implantation, STI was performed under the condition of 100% ventricular pacing and desynchronization data of longitude, circumferential, and radial strain was recorded. Results In RVA group, time difference （TD） of time to peak strain on longitude strain （LS） and circumferential strain （CS） of left ventricle systole was （191.07±39.24）ms and （135.92±33.40）ms, while in RVOT group was （129.18±26.20）ms and （69.78：t： 19.10）ms, respectively. Standard difference （SD） of LS and CS in RVA group was （62.90±12.63）ms and （52.62±13.58）ms, while in RVOT group was （41.62±5.71）ms and （28.54±7.96）ms, respectively. The differences of TD and SD between two groups were significant （all P〈0. 001）. TD of radial strain （RS） in RVA group and RVOT group was （105.43±58.08） ms and （42.00±21.39）ms, SD was （41.98±29.48）ms and （17.08±10.46）ms, respectively. Both TD and SD between two groups had statistical difference （both P〈0. 005）. Conclusion The left ventricular synchronization of RVOT pacing is ：. superior to RVA pacing.