二维斑点追踪成像与实时三维超声心动图评价不同部位起搏器植入术后左心室收缩功能与同步性

Left Ventricular Systolic Function and Synchronicity After Pacemaker Implantation on Different Locations by Two-dimensional Speckle Tracking Imaging and Real-time Three-dimensional Echocardiography

目的应用二维斑点追踪成像(2D-STI)及实时三维超声心动图(RT-3DE)评价右心室不同部位起搏器植入术后左心室收缩功能及同步性,并研究两种技术的一致性。资料与方法收集2016年9月-2017年5月于重庆医科大学附属第二医院行永久性心脏双腔起搏器植入术的患者27例,并根据起搏器植入部位不同分为右心室心尖部(RVA)起搏组及右心室流出道(RVOT)起搏组。分别于术前及术后1个月采用2D-STI和RT-3DE获取患者的左心室射血分数(LVEF)、纵向应变及同步性参数,并分析同步性参数左心室18节段达峰时间的标准差(Tp-SD)与左心室16节段达最小收缩末期容积时间的标准差占心动周期的百分比(Tmsv-16-SD%)的相关性。结果两组术后LVEF较术前显著减低(P<0.05)。RVA组术后左心室心尖段纵向收缩期峰值应变较术前明显增大(P<0.05)。两组术后左心室收缩同步性参数均较术前明显升高(P<0.05),其中RVA组较RVOT组增大更为显著,Tp-SD、左心室18节段达峰时间的最大差、左心室16节段达最小收缩期容积时间的最大差、左心室16节段达最小收缩期容积时间最大差占心动周期的百分比差异有统计学意义(P<0.05)。同步性参数Tp-SD与Tmsv-16-SD%参数呈显著正相关(r=0.775,P<0.001)。结论两组术后左心室收缩功能均较术前减低。RVA组及RVOT组术后均引起左心室收缩不同步,但RVOT组左心室收缩同步性优于RVA组。2D-STI和RT-3DE均可定量评价左心室收缩同步性,且一致性较好。

Purpose To evaluate left ventricular systolic function and synchronicity after pacemaker implantation on different locations of right ventricle by twodimensional speckle tracking imaging（2 D-STI） and real-time three-dimensional echocardiography（RT-3 DE） and to explore the correlation of the two techniques. Materials and Methods Twenty-seven patients who received permanent cardiac dual-cavity pacemaker implantation in the Second Affiliated Hospital of Chongqing Medical University from September 2016 to May 2017 were enrolled and divided into right ventricle apex（RVA） pacing group and right ventricle outflow tract（ROVT） pacing group in line with different implantation parts. 2 D-STI and RT-3 DE were taken to obtain left ventricular ejection fraction（LVEF）, longitudinal strain and synchronic parameters of the patients one month before and after the surgery. Meanwhile for synchronic parameters, correlation analysis of percentage（Tmsv-16-SD%） of standard deviation（Tp-SD） of time when the 18 th section of the left ventricle reached peak and the standard deviation of volume when the 16 th section of the left ventricle reachd minimum end-systole in cardiac cycle would be developed. Results Postoperative LVEF in two groups was obviously decreased compared with that before the surgery（P〈0.05）. Postoperative longitudinal systolic peak of the left ventricle apex section in RVA group was significantly increased compared with that before the surgery（P〈0.05）. Left ventricular systolic synchronic parameters in the two groups were obviously enhanced compared with those before surgery（P〈0.05）, among which enhancement in RVA group was more obvious than that in ROVT group. Difference of Tp-SD, maximum difference of time of the 18 th section of the left ventricle reaching peak and time of the 16 th section of the left ventricle reaching minimum systolic volume and percentage of maximum difference of minimum systolic volume time of the 16 th section of the left ventricle in cardiac cycle was statistically significant（P〈0.05）. TpSD was positively correlate with Tmsv-16-SD%（r=0.775, P〈0.001）. Conclusion Postoperative systolic functions of left ventricle in the two groups are decreased compared with those before the surgery. Left ventricular systolic dyssynchrony after the surgery is caused in RVA group and RVOT group, but left ventricular systolic dyssynchrony in RVOT group is better than that in RVA group. 2 D-STI and RT-3 DE can be used for quantitative analysis of left ventricular systolic synchronicity with good correlation.