三维斑点追踪成像技术评估右心双腔间隔起搏对左心室功能的影响

3D speckle tracking imaging in evaluation of left ventricular function in patients with right ventricular dual chamber septal pacing

目的应用三维斑点追踪成像(3D-STI)评估右心双腔间隔起搏对左心室功能的影响。方法对42例右心双腔间隔起搏患者(起搏器组)和37名健康志愿者(对照组)行3D-STI检查,于心尖四腔切面图像获得左心室总体纵向峰值应变(GLS)、总体周向峰值应变(GCS)、总体径向峰值应变(GRS)、总体面积峰值应变(GAS)及左心室总体拧转(GTw)和左心室整体扭转(GTs)值。比较2组间三维应变参数,并分析GTw、GTs与GLS、GCS、GAS及GRS的相关性。结果与对照组相比,起搏器组左心室GLS、GCS、GAS、GRS及GTs均明显减低(P均<0.05);2组间GTw差异无统计学意义(P>0.05)。对照组GTs与GCS和GRS呈正相关(r=0.45、0.40;P均<0.05),与GAS、GLS无相关性(P均>0.05);GTw与GLS、GCS、GAS、GRS均无相关(P均>0.05)。起搏器组GTw、GTs与GLS、GCS、GAS、GRS均无相关(P均>0.05)。结论右心双腔间隔起搏可损害左心室心肌形变能力,致左心室整体收缩功能隐匿性减低。

Objective To evaluate the impact of right ventricular double-chamber septal pacing（RVSP）on left ventricular function with 3D speckle tracking imaging（3D-STI）technology.Methods 3D-STI was performed in 42 patients with RVSP（RVSP group）and 37 healthy volunteers（control group）.The global longitudinal strain（GLS）,global radial strain（GRS）,global area strain（GAS）,global circumferential strain（GCS）,global twist（GTw）and global torsion（GTs）of the left ventricle were obtained on apical four-chamber images.3D strain parameters were compared between the two groups,and the correlations of GTw,GTs and GLS,GCS,GAS and GRS were analyzed.ResultsCompared with those of control group,GLS,GRS,GCS,GAS and GTs decreased in RVSP group（all P〈0.05）.There was no significant difference of GTw between the two groups（P〉0.05）.In control group,there were positive correlations between GTs and GCS as well as between GTs and GRS（r=0.45,0.40;both P〈0.05）,while GTs showed no correlation with GAS nor GLS,GTw had no correlation with GLS,GCS,GRS nor GAS（all P〉0.05）.In RVSP group,GTs and GTw revealed no correlation with GLS,GCS,GRS nor GAS（all P〈0.05）.Conclusion RVSP can impair left ventricular myocardial deformability,resulting in reduced left ventricular systolic function.