不同起搏部位对左室收缩同步性及整体收缩功能早期影响的实时三维超声心动图研究

Acute Impact on Left Ventricular Systolic Synchrony and Global Systolic Function in Patients with Different Right Ventricular Site Pacing by Real-time Three-dimensional Echocardiography

目的探讨应用实时三维超声心动图(RT-3DE)评价右室不同部位起搏对左室收缩同步性及整体收缩功能的早期影响。方法 60例房室顺序双心腔起搏器植入的患者,根据起搏部位不同分为右室流出道(RVOT)组及右室心尖(RVAP)组。两组患者均于术前及术后1周应用RT-3DE采集左心室全容积图像并应用在机Qlab 8.1分析软件,获得左心室整体与16节段容积-时间曲线和左心室16、12、6节段自心电图QRS波起点至左心室最小收缩末容积点时间的标准差和最大时间差(即Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)作为左室收缩同步性参数;同时获得左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、每搏量(SV)、左心室射血分数(LVEF)作为左室整体收缩功能参数。结果术前两组左室收缩同步性参数Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif和整体收缩功能参数LVEDV、LVESV、SV、LVEF比较差异均无统计学意义(P>0.05)。术后1周,RVAP组左室收缩同步性参数与术前比较延长(P<0.05),与RVOT组比较亦延长(P<0.05),RVOT组左室同步性参数术前术后比较差异无统计学意义(P>0.05)。左室整体收缩功能参数在两组内术前术后比较及术后组间比较差异均无统计学意义(P>0.05)。结论与RVAP起搏比较,RVOT起搏更有利于保持起搏状态下左室同步性,是一种更符合生理的起搏方式。RT-3DE可客观、准确地评价左室收缩同步性及整体收缩功能。

Objective To evaluate acute impact on left ventricular systolic synchrony and global systolic function in patients with different right ventricular site pacing by real- time three- dimensional echocardiography( RT- 3DE). Methods 60 patients with DDD mode cardiac pacemakers were divided into two groups according to different pacing site : RVOT pacing group and RVA pacing group. Patients in two groups were evaluated before operation and 1 week after the operation by RT- 3DE to obtain full volume images,and those images were analyzed by the Qlab 8. 1 software. Some parameters including global and 16- segmental volume-time curves( VCTs),dispersion of time from the start of electrocardiographic QRS wave to the point of minimal regional volume for 16,12,and 6 left ventricular segments( Tmsv16- SD,Tmsv12- SD,Tmsv6- SD),maximal difference of time to minimal regional volume for 16,12 and 6 left ventricular segments( Tmsv16-Dif,Tmsv12- Dif,Tmsv6- Dif),and left ventricular end- diastolic volume( LVEDV),left ventricular end-systolic volume( LVESV),stroke volume( SV),left ventricular ejection fraction( LVEF) were measured respectively. Results There were no significant difference in all the parameters( Tmsv16- SD,Tmsv12- SD,Tmsv6- SD,Tmsv16- Dif,Tmsv12- Dif,Tmsv6- Dif and LVEDV,LVESV,SV,LVEF) between two groups before operation( P > 0. 05). At 1 week after the operation,the left ventricular systolic synchrony parameters including( Tmsv16- SD,Tmsv12- SD,Tmsv6- SD,Tmsv16- Dif,Tmsv12- Dif,Tmsv6- Dif) of RVA pacing group were significantly prolonged( P < 0. 05) compared with before and RVOT pacing group,but those parameters of RVOT pacing group were not changed compared with before( P > 0. 05). The left ventricular global systolic function parameters including( LVEDV,LVESV,SV,LVEF) were not changed( P > 0. 05). Conclusion Compared with RVAP,RVOT pacing is closely accordance with physiological pacing. RT- 3DE is an accurate and objective method to evaluate left ventricular systolic synchrony and global systolic function.