心肌代谢显像评价老年患者心室不同部位起搏的心室机械不同步性

Cardiac mechanical dyssynchrony in pacing in different ventricular parts in elderly patients using myocardial metabolic imaging

目的应用心肌代谢显像评价心室不同部位起搏对左心室机械不同步性的影响。方法选择2023年1~11月复旦大学附属上海市第五人民医院行永久起搏器置入术的老年患者56例,随机分为左束支区域起搏(LBBAP)组和右心室起搏(RVP)组,各组28例,另选取28例未行起搏器置入术的老年患者作为对照组。起搏器置入术后1周内行^(18)F-氟代脱氧葡萄糖(^(18)F-FDG)正电子发射断层显像(PET)/CT心肌代谢显像,进行PET心肌代谢影像分析和左心室机械同步性评价。结果对照组患者左心室射血分数(LVEF)显著高于LBBAP组和RVP组[(67.68±9.61)%vs(62.71±11.33)%vs(57.36±16.07)%,P=0.012];LBBAP组与RVP组LVEF比较无显著差异(P>0.05)。与RVP组比较,LBBAP组角度标准差(PSD)、相位带宽、熵、室壁运动总评分(SMS)、室壁增厚总评分(STS)、室壁运动异常范围占中段心肌表面积的百分比(Mot Ext)、室壁增厚异常范围占中段心肌表面积的百分比(Thk Ext)显著降低,差异有统计学意义(P<0.01)。LBBAP组与对照组PSD、相位带宽、熵、SMS、STS、Mot Ext、Thk Ext等比较差异无统计学意义(P>0.05)。结论^(18)F-FDG PET/CT心肌代谢显像对心室不同部位起搏进行左心室机械同步性评价显示,LBBAP左心室同步性参数优于RVP,与对照组相近。

Objective To evaluate the effect of pacing in different parts of the ventricle on left ventricular mechanical asynchrony using myocardial metabolic imaging.Methods A total of 56 elderly patients undergoing permanent pacemaker implantation in our hospital from January to November 2023 were recruited and randomly divided into left bundle branch pacing(LBBAP)group and right ventricular pacing(RVP)group,with 28 patients in each group.Another 28 elderly patients who did not undergo pacemaker implantation surgery were selected as the control group.Within 1 week after pacemaker implantation,^(18)F fluorodeoxyglucose(^(18)F-FDG)positron emission tomography(PET)/CT myocardial metabolism imaging was performed to analyze PET myocardial metabolism images and evaluate left ventricular mechanical synchrony.Results The LVEF was significantly higher in the control group than the LBBAP group and RVP group[(67.68±9.61)%vs(62.71±11.33)%vs(57.36±16.07)%,P=0.012],but no such difference was seen between the LBBAP group and the RVAP group(P>0.05).The LBBAP group had obviously lower pattern standard deviation(PSD),phase histogram bandwidth(PHBW),entropy,summed motion score(SMS),summed thickening score(STS),extent of abnormal motion(Mot Ext)and thickening extent(Thk Ext)when compared with the RVP group(P<0.01).There were no statistical significant differences in the terms of PSD,PHBW,Entropy,SMS,STS,Mot Ext,and Thk Ext between the LBBAP group and the control group(P>0.05).Conclusion^(18)F-FDG PET/CT myocardial metabolic imaging can be used to evaluate left ventricular mechanical synchrony in pacing different parts of the ventricle,and LBBAP can obtain better left ventricular synchrony parameters than RVP,similar to the control group.