实时三维超声心动图对高度房室传导阻滞伴射血分数保留的心力衰竭患者左束支区域起搏后左心室功能及同步性的评价

Evaluation of left ventricular systolic function and synchrony in advanced atrioventricular block patients with heart failure with preserved ejection fraction after left bundle branch area pacing by real-time three-dimensional echocardiography

目的应用实时三维超声心动图(RT-3DE)评价高度房室传导阻滞(AAVB)伴射血分数保留的心力衰竭患者(HFpEF)左束支区域起搏(LBBAP)后左心室功能和同步性的变化。方法回顾性分析于2020年12月至2021年8月就诊于辽宁省人民医院植入心脏起搏器并行LBBAP的AAVB患者45例,按其是否合并HFpEF分为AAVB无HFpEF组29例和AAVB伴HFpEF组16例。应用超声心动图获得术后3 d、术后1个月超声参数,同时应用RT-3DE获得三维参数,主要包括左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、每搏量(LVSV)、左心室射血分数(LVEF)、经心率校正后的左心室16节段最小收缩容积时间的标准差(Tmsv16-SD)及最大时间差(Tmsv16-Dif)。分别对比2组术后3 d、术后1个月左心室收缩功能及同步性的改善情况。结果术后1个月与术后3 d相比较,AAVB无HFpEF组的LAD、LAVI、LVEDD、E、e'、E/e'、LVEDV、LVESV、LVSV、LVEF、Tmsv16-SD、Tmsv16-Dif差异均无统计学意义(P均>0.05);术后1个月与术后3 d相比较,AAVB伴HFpEF组的LAD、LAVI、LVEDD、E、LVEDV、LVESV、LVSV、LVEF差异均无统计学意义(P均>0.05),术后1个月e'升高,E/e'、Tmsv16-SD、Tmsv16-Dif减低,差异均有统计学意义(P均<0.05)。应用Pearson法分析AAVB伴HFpEF组LBBBAP术后NT-proBNP水平与Tmsv16-SD、Tmsv16-Dif均呈正相关(r=0.395、0.466;P=0.032、0.007)。结论LBBAP作为一种新的生理起搏模式,术后1个月即可有效改善AAVB伴HFpEF患者左心室舒张功能及其同步性,其对于AAVB伴HFpEF患者的治疗效果较无HFpEF患者显著。

Objective To evaluate the changes of left ventricular function and synchrony in advanced atrioventricular block(AAVB)patients with heart failure with preserved ejection fraction(HFpEF)after left bundle branch area pacing(LBBAP)using real-time three-dimensional echocardiography(RT-3DE).Methods A total of 45 AAVB patients with pacemaker implantation and LBBAP pacing at People's Hospital of Liaoning Province from December 2020 to August 2021 were enrolled.According to whether they were combined with HFpEF,the patients were divided into either an AAVB without HFpEF group(29 cases)or an AAVB with HFpEF group(16 cases).Echocardiography was used to obtain ultrasound parameters 3 days and 1 month after surgery,and RT-3DE was performed to obtain three-dimensional parameters,including left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular stroke volume(LVSV),left ventricular ejection fraction(LVEF),standard deviation of the minimum systolic volume time(Tmsv16-SD),and maximum time difference(Tmsv16-Dif)of the 16 segments of the left ventricle after heart rate correction.The improvement of left ventricular systolic function and synchronization between the two groups were compared 3 days and 1 month after surgery.Results Compared with the values obtained at 3 days after operation,LAD,LAVI,LVEDD,E,e',E/e',LVEDV,LVESV-3D,LVSV,LVEF,Tmsv-16-SD,and Tmsv16-Dif at 1 month after operation did not differ significantly in the AAVB without HFpEF group(P>0.05).Compared with the values obtained at 3 days after operation,LAD,LAVI,LVEDD,E,LVEDV,LVESV,LVSV,and LVEF at 1 month after operation did not differ significantly in the AAVB with HFpEF group(P>0.05),but e'increased significantly and E/e',Tmsv16-SD,and Tmsv16-Dif decreased significantly(P<0.05).Pearson correlation analysis showed that postoperative NT-proBNP levels at three days and one month after LBBBAP in AAVB patients were positively correlated with Tmsv16-SD and Tmsv16-Dif(r=0.395,P=0.032;r=0466,P=0.007).Conclusion As a new physiological pacing mode,LBBAP can effectively improve the left ventricular diastolic function and synchronization in patients with AAVB and HFpEF one month after surgery.The effect is more significant in AAVB patients with HFpEF than in those without.