组织多普勒成像评价左束支传导阻滞时不同步心室活动  

Assess dyssynchrony in left bundle branch block by tissue Doppler imaging

作　　者：张涓[1] 杨新春[1] 吴雅峰[2] 崔亮[1] 王丽[2] 吴江[2] 姜维[2] 张苹娜[2] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,北京100020 [2]首都医科大学附属北京朝阳医院超声医学科,北京100020

出　　处：《中华超声影像学杂志》2004年第10期748-752,共5页Chinese Journal of Ultrasonography

摘　　要：目的　超声评价左束支传导阻滞 (LBBB)患者局部心肌的纵向运动。方法　超声测量 15例LBBB患者和 15例正常人各瓣环 ,获得纵向上不同时相的峰值速度 (VS、VE、VA)、持续时间 (IVC、S、IVR、D)、最大时间 速度积分 (TVImax)和最大下移距离 (Dmax) ,以及心电图QRS波起点到S波起点的时间 (Q Sb)、到S波顶点的时间 (TTP)、E波的减速时间 (Edc)等。结果　LBBB患者左室室间隔、下后壁和前壁瓣环VS、VE、TVImax、Dmax明显减低 ,Q Sb、TTP明显延长 ;左室室间隔、下后壁的IVC、IVR延长 ,D缩短 ,IVC/S增高。结论　LBBB时左室激动顺序异常 ,引起左室整体和局部舒缩功能异常 ;左室各壁出现不同程度的收缩延迟 ,心室内不同步明显 ;右室收缩延迟不明显 ,左。Objective To observe longitudinal motion characteristics of regional myocardium in left bundle branch block(LBBB) patients. Methods Left ventricular regional myocardium of 15 LBBB patients and 15 normal subjects were assessed by tissue Doppler imaging(TDI). Peak velocities(V_S,V_E,V_A) during isovolumic contraction, ejection, isovolumic relaxation, early relaxation, atrial systole phases and maximum time velocity integral(TVI_(max)), displacement(D_(max)) in mitral(tricuspidal) annulets of different walls were measured. Furthermore, the different parameters from the beginning of electrocardiogram QRS wave to the beginning of S wave(Q-Sb),to the tip of S wave(TTP), the acceleration time of IVC wave(IVA), the acceleration time of the E wave(Eac),the durations of different phases(IVC,S,IVR,D)and IVC/S and others were acquired. Results Peak velocities(V_S,V_E)and TVI_(max) in left ventricular septal, inferior, anterior, posterior walls were lower in LBBB group than control group; those parameters in different segments of left and right ventricular lateral myocardium were not significantly lower in LBBB group than control group. What is more, D_(max) of mitral annular sites in LBBB group were lower than control group. Q-Sb, TTP and IVC in left ventricular septal, inferior, anterior, posterior walls were longer in LBBB group than in control group; IVA lengthened, Eac and Edc shortened in left ventricular septal, inferior walls; IVR lengthened, diastole shortened, IVC/S increased in left ventricular septal, inferior, and posterior walls. Conclusions Abnormal left ventricular activation sequence during LBBB caused obvious impairment in total and regional systolic and diastolic function. And delayed contraction with different degrees were resulted from different walls of left ventricle with intraventricular dyssynchrony; but contraction in right ventricle was not significantly delayed, with interventricular dyssynchrony.

关 键 词：左室 LBBB 心室 左束支传导阻滞 患者 室间隔 TVI IVC VE VA 

分 类 号：R445.1[医药卫生—影像医学与核医学]