三维斑点追踪成像技术评价心室起搏管理对病态窦房结综合征患者左室收缩功能的影响

Effects of Managed Ventricular Pacing on Left Ventricular Systolic Function in Patients with Sick Sinus Syndrome Using Three-dimension Speckle Tracking Imaging

目的探讨实时三维斑点追踪成像(real-time three-dimension speckle tracking imaging,RT3D-STI)技术评价心室起搏管理(managed ventricular pacing,MVP)对病态窦房结综合征(sick sinus syndrome,SSS)患者左室收缩功能的影响。方法选择2011年11月至2016年12月50例植入具有MVP功能双腔起搏器(Medtronic Adapta ADD01/ADDR01/ADDRL1)的SSS患者,先以双腔起搏(DDD/R)模式工作6个月,再程控为MVP模式工作6个月,统计两种模式下右心室起搏比例;测量两种模式下射血分数(LVEF); RT3D-STI测量两种模式下左室整体长轴应变(GLS)、整体轴向应变(GCS)、整体径向应变(GRS)及整体面积应变(GAS)。结果 DDD/R模式组患者的LVEF与MVP模式组比较有所降低,但差异未达到统计学意义(P>0. 05);而RT3D-STI测量的GLS、GCS、GRS、GAS与MVP模式组比较,均有统计学意义; DDD/R模式组累计心室起搏比例明显高于MVP模式组,差异有统计学意义(P<0. 05)。结论对于植入双腔起搏器的SSS患者,与DDD/R模式组比较,MVP模式能显著减少右心室起搏比例从而保护心功能。RT3D-STI技术可以评估早期左室收缩功能变化。

Objective To evaluate the application of real-time three-dimensional speckle tracing imaging(RT3D-STI)in evaluating the effect of managed ventricular pacing(MVP)on left ventricular systolic function in patients with sick sinus syndrome(SSS).Methods Fifty patients of sick sinus syndrome,implanted a dual chamber pacemaker with MVP function(Medtronic Adapta ADD01/ADDR01/ADDRL1),were included from November 2011to December 2016.Dual chamber pacing(DDD/R)mode was used for the first 6months and MVP mode was used for the second 6months,then we calculated the right ventricular pacing ratio and measured the ejection fraction(LVEF)in both modes.The global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS),and global area strain(GAS)were measured in both modes with RT3D-STI.Results The LVEF of DDD/R model group was lower than that of MVP model group,but the difference was not significant(P>0.05).The GLS,GCS,GRS,and GAS measured by RT3D-STI was significantly higher in DDD/R model group compared with the MVP model group.The cumulative ventricular pacing ratio in DDD/R group was significantly higher than that in MVP model group(P<0.05).Conclusion Compared with DDD/R mode,MVP mode can significantly reduce the right ventricular pacing ratio and protect cardiac function for SSS patients with dual chamber pacemaker implantation.RT3D-STI technique can be used to evaluate the early changes of left ventricular systolic function.