二维斑点追踪技术评价左束支区域起搏早期左心室收缩功能及同步性

Evaluation of early left ventricular systolic function and synchronicity of left bundle branch pacing using two-dimensional speckle tracking imaging

目的运用二维斑点追踪(2D-STI)技术评价左束支区域起搏(LBBP)早期左心室收缩功能及同步性。方法选取2019年7月至2020年1月在成都市第三人民医院成功实施起搏器植入的患者42例。根据起搏器植入部位不同,将其分为LBBP患者20例,右心室流出道起搏(RVOP)患者22例。患者均于术后2周行超声心动图检查。应用2D-STI技术分析和获取2组患者的左心室整体纵向应变(GLS)、左心室17节段心肌收缩期纵向应变达峰时间标准差(SDt-17),以及各水平纵向应变(LS)及纵向应变达峰时间标准差(SDt)。比较2组的超声心动图及2D-STI参数,并分析SDt-17与GLS的相关性。结果与RVOP组相比,LBBP组SDt-17、基底段SDt及中间段SDt减小,差异均有统计学意义(P=0.001、0.003、0.046)。心尖段SDt在2组间差异无统计学意义(P>0.05)。左心室GLS、基底段LS、中间段LS、心尖段LS在LBBP组与RVOP组间差异均无统计学差异(P均>0.05)。LBBP组左心室SDt-17与GLS呈正相关性,相关系数为0.542(P=0.014);RVOP组左心室SDt-17与GLS呈正相关性,相关系数为0.540(P=0.009)。结论运用2D-STI技术能够客观、精确地评价左心室整体收缩功能及同步性。LBBP在术后早期即会对左心室收缩同步性产生积极作用。

Objective To assess early left ventricular systolic function and synchronicity of left bundle branch pacing using two-dimensional speckle tracking imaging(2D-STI).Methods A total of 42 patients who received permanent cardiac implantation from July 2019 to January 2020 at the Third People's Hospital of Chengdu were enrolled.The patients were divided into a left bundle branch pacing(LBBP)group(n=20)or a right ventricular out flow tract pacing(RVOP)group(n=22)according to the pacing site.Echocardiography was performed two weeks after the surgery.The global longitudinal strain(GLS)of the left ventricle and standard deviation of left ventricular 17 segments peak strain time(SDt-17),as well as longitudinal strain(LS)and the standard deviation peak strain time(SDt)at the mitral valve,papillary muscle,and apex levels were analyzed and obtained using 2D-STI.Echocardiography and 2D-STI parameters were compared between the two groups.Correlation analysis was performed between SDt-17 and GLS in each group.Results Compared with the values in the RVOP group,the values of SDt-17 and SDt at the mitral valve and papillary muscle levels in the LBBP group decreased significantly(P=0.001,0.003,0.046).There was no difference in the SDt at the apex level,and in the GLS and LS at the mitral valve,papillary muscle,and apex levels between the LBBP and RVOP groups(P>0.05).Univariate correlation revealed that the SDt-17 was positively correlated with GLS in both the LBBP group(r=0.543,P=0.014)and the RVOP group(r=0.540,P=0.009).Conclusion 2D-STI is an objective and accurate method to evaluate left ventricular global systolic function and synchrony.The protective effect of LBBP on left ventricular systolic synchrony will be demonstrated as time goes by.