二维斑点追踪技术评价的不同类型完全左束支传导阻滞预测心脏再同步化治疗患者急性反应的价值

Value of different patterns of complete left bundle branch block evaluated by two-dimensional speckle tracing echocardiography in predicting acute response of patients with cardiac resynchronization therapy

目的 探讨二维斑点追踪技术(2D-STE)评价的不同类型完全左束支传导阻滞(CLBBB)预测接受心脏再同步化治疗(CRT)的慢性充血性心力衰竭(CHF)患者急性反应的临床价值。方法 选取36例接受CRT的CHF合并CLBBB患者,分别在CRT关闭和开启状态接受超声心动图检查,并将CRT开启时左室射血分数(LVEF)增加≥5%设为有反应,<5%设为无反应。根据左室后室间隔纵向时间-应变曲线类型,将CLBBB分为Ⅰ型、Ⅱ型、Ⅲ型。将Ⅰ型和Ⅱ型设为研究组1,Ⅲ型设为研究组2,在CRT关闭状态下测量常规超声参数、收缩功能参数、收缩不同步参数。结果 36例患者中,有反应者为29例(80.56%),无反应者为7例(19.44%);CLBBBⅠ型患者20例,Ⅱ型4例,Ⅲ型12例。研究组1有22例患者CRT急性反应有效,应答有效率为91.67%(22/24);研究组2有7例患者CRT急性反应有效,应答有效率为58.33%(7/12);研究组1患者CRT急性反应的应答有效率高于研究组2患者,差异有统计学意义(P<0.05)。2组患者的左室内径、左室收缩功能、左室舒张功能、室间不同步参数比较,差异无统计学意义(P>0.05)。研究组1的室间隔整体纵向峰值应变、侧壁整体纵向峰值应变均小于研究组2,差异有统计学意义(P<0.05)。研究组1的左室18节段峰值应变达峰时间的标准差大于研究组2,差异有统计学意义(P<0.05)。结论 不同类型CLBBB急性反应的应答有效率有差异;CLBBBⅠ、Ⅱ型急性反应的应答有效率优于CLBBBⅢ型;CLBBBⅠ、Ⅱ型室间隔及左室侧壁功能优于CLBBB III型;CLBBBⅠ、Ⅱ型左室内收缩不同步性较CLBBBⅢ型显著。

Objective To explore the clinical value of different patterns of complete left bundle branch block(CLBBB)evaluated by two-dimensional speckle tracing echocardiography(2D-STE)in predicting acute response of chronic congestive heart failure(CHF)patients with cardiac resynchronization therapy(CRT).Methods A total of 36 patients with CHF and CLBBB by CRT were selected and conducted with echocardiography examination in the ON and OFF states of CRT,and the increase of left ventricular ejection fraction(LVEF)≥5%at ON state of CRT was defined as responsive,while the increase of LVEF<5%was defined as unresponsive.According to the longitudinal time-strain curve types of left ventricular posterior interventricular septum,CLBBB was divided into typeⅠ,typeⅡand typeⅢ.Patients with typeⅠand typeⅡwere set as study group 1,patients with typeⅢwere set as study group 2,and the conventional ultrasound parameters,systolic function parameters and systolic asynchrony parameters were detected at the OFF state of CRT.Results Among the 36 patients,there were 29 cases(80.56%)with response and 7 cases(19.44%)without response;there were 20 patients with typeⅠCLBBB,4 patients with typeⅡ,and 12 patients with typeⅢ.There were 22 patients with effective response to acute response of CRT in the study group 1,and the effective rate of response was 91.67%(22/24);in the study group 2,7 patients had effective response to acute response of CRT,and the effective rate of response was 58.3%(7/12);the effective rate of response to acute response of CRT in the study group 1 was significantly higher than that in the study group 2(P<0.05).There were no significant differences in left ventricular diameter,left ventricular systolic function,left ventricular diastolic function and ventricular asynchrony parameters between the two groups(P>0.05).The overall longitudinal peak strain of the interventricular septum and the overall longitudinal peak strain of the lateral wall in the study group 1 were significantly lower than those in the study group 2(P<0.05).The standard deviation of the peak time of left ventricular strain at 18 segments in the study group 1 was significantly greater than that in the study group 2(P<0.05).Conclusion There are differences in response efficiency of acute response among different types of CLBBB;the response efficiency of acute response in typeⅠandⅡCLBBB is better than that of typeⅢCLBBB;the function of interventricular septum and left ventricular sidewall in typeⅠandⅡCLBBB is better than that of typeⅢCLBBB;the left ventricular systolic asynchrony of typeⅠandⅡCLBBB is more significant than that of typeⅢCLBBB.