实时三维超声心动图观察右室不同部位起搏对左室收缩同步性及整体收缩功能的影响

Assessment of Left Ventricular Systolic Synchrony and Global Systolic Function in Patients with Different Right Ventricular Site Pacing by Real- time Three- Dimensional Echocardiography

目的动态观察右室不同部位起搏对左室收缩同步性及整体收缩功能的影响。方法应用实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)采集30例右室心尖部起搏(right ventricular apex pacing,RVAP)组及30例右室流出道(right ventricular outflow tract,RVOT)起搏患者术前及术后1周、3个月、6个月的三维全容积图像。通过分析软件获得左心室整体与16节段容积-时间曲线并计算出左室整体收缩功能及左心室16、12、6节段达到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)。结果术前RVAP组与RVOT组各指标比较差异均无统计学意义(P>0.05)。RVAP组术后1周、3个月、6个月的Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif与术前相比明显延长(P均<0.05),LVEDV、LVESV、SV、LVEF手术前后差异无统计学意义(P>0.05)。RVOT组与术前相比,术后1周、3个月、6个月的Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif、LVEDV、LVESV、SV、LVEF变化差异均无统计学意义(P均>0.05)。术后与RVOT组同期比较,RVAP组术后1周、3个月、6个月的Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif明显延长(P均<0.05),LVEDV、LVESV、SV、LVEF两组间差异无统计学意义(P>0.05)。结论 RVOT起搏因其更符合生理的传导方式使其介导下的左室收缩同步性优于RVAP。RT-3DE能够准确测量并客观评价左室收缩同步性及整体收缩功能。

Objective To dynamically observe impact of different right ventricular site pacing on left ventricular systolic synchrony and global systolic function. Methods 30 patients with right ventricular apex pacing and 30 patients with right ventricular outflow tract were evaluated before operation and 1 week,3 months,6months after the operation by RT- 3DE to obtain full volume images. Left ventricular global and 16- segmental volume- time curves were obtained by analysis software. Dispersion of time and maximal difference of time for 16,12,and 6 left ventricular segments to the point of minimal regional volume( Tmsv16- SD,Tmsv12- SD,Tmsv6- SD,Tmsv16- Dif,Tmsv12- Dif,Tmsv6- Dif) and left ventricular global systolic function were measured. Results There were no significant difference in all of indexbetween two groups before operation( P all > 0. 05). At the 1stweek,3rdmonths,6thmonths after the operation,the 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 while the LVEDV,LVESV,SV,LVEF did not change at the same time( P > 0. 05). The Tmsv16- SD,Tmsv12- SD,Tmsv6- SD,Tmsv16- Dif,Tmsv12- Dif,Tmsv6- Dif,LVEDV,LVESV,SV,LVEF of RVOT pacing group did not changed compared with before( P > 0. 05). Compared with RVOT pacing group,at 1stweek,3rdmonths,6thmonths after the operation,the Tmsv16- SD,Tmsv12- SD,Tmsv6- SD,Tmsv16- Dif,Tmsv12- Dif,Tmsv6- Dif of RVA pacing group were significantly prolonged( P < 0. 05),while the LVEDV,LVESV,SV,LVEF did not changed( P > 0. 05). Conclusion The left ventricular systolic synchrony of RVOT are superior to RVAP. RT- 3DE can evaluate left ventricular systolic synchrony and global systolic function accurately.