定量组织速度成像技术评价病态窦房结综合征伴房室传导延迟AAI与DDD模式心肌节段运动  

Quantitative tissue velocity imaging in evaluating ventricular segments motion of AAI mode and DDD mode on sick sinus syndrome with prolonged atrioventricular delay

作　　者：陈晓栋[1] 许迪[1] 周蕾[1] 雍永宏[1] 陈莉[1] 王璎瑛[1] 张荣[1] 廖铭扬[1] 

机构地区：[1]南京医科大学第一附属医院心脏科超声心动图室,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2007年第6期586-589,F0003,共5页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:对病态窦房结综合征(SSS)伴房室传导延迟的患者分别设置为AAI和DDD模式,通过定量组织速度成像技术(QTVI)对两种模式时各节段心肌的运动分析,探讨起搏模式对心功能的影响。方法:选择SSS伴Ⅰ度房室传导阻滞的患者24例,分别设置为AAI模式和AV间期优化的DDD起搏模式,运用QTVI比较这两种起搏模式下心肌节段收缩峰值速度(Vs),舒张早期速度(Ve),舒张晚期速度(Va)和位移(D)。结果:在左室多数基底段及右室游离壁基底段Vs和Ve在AAI模式时大于DDD模式时(P<0.05);前间隔基底段Vs及下壁基底段的Ve在两种模式下尽管无统计学差异,但AAI模式较DDD模式有增大的趋势;基底段的Va在两种模式下差异无显著性(P>0.05)。左室心肌中段和右室游离壁心肌中段的Vs、Ve、Va及左室和右室游离壁基底段、中段的D在AAI模式和DDD模式间差异无显著性(P>0.05)。结论:①SSS伴房室传导延迟(PR>200ms且<260ms)患者AAI起搏模式下心脏的收缩和舒张功能均优于AV间期优化的DDD起搏模式;②QTVI可早期显示AAI和DDD起搏状态心肌运动状态的变化,有助于选择合适的起搏模式。Objective：To evaluate ventricular segments motion on AAI mode and DDD mode with optimal atrioventricular interval by the quantitative tissue velocity imaging （QTVI）, and to investigate whether AAI pacing mode was superior to the DDD pacing mode with optimal atrioventricular interval in sick sinus syndrome （SSS） patients with I degree atrioventricular block （I°AVB）. Methods：Twenty four patients with implanted DDD pacemakers for SSS with I°AVB （PR interval 〉 200 ms and 〈 260 ms） were studied at four-chamber view, two-chamber view and apical longitudinal view using QTVI. The regional parameters, including peak sustained velocity（Vs）, peak early diastolic velocity（Ve）, peak late diastolic velocity（Va） and peak systolic displacement（D） of the basal and middle segments in left ventricle （anterior septal, anterior, lateral, posterior, inferior and septal wall） and in the free wall of right ventricle were measured. Results：There were significant differences in the parameters （Vs, Ve） of most basal segments between AAI group and DDD group （P 〈 0.05）. There were no significant differences in other parameters between both modes （P 〉 0.05）. Conclusion： （1） In AAI pacing mode, ventricular systolic and diastolic function are superior to DDD pacing mode with optimal atrioventricular interval in patients with SSS, which intrinsic AV conduction are moderately prolonged; （2）The change of ventricle segments motion can be early evaluated by QTVI in AAI and DDD mode, and it is useful to determine the optimal pacing mode in SSS patients with I° AVB.

关 键 词：定量组织速度成像 组织多普勒 优化的AV间期 双腔起搏器 房室传导延迟 

分 类 号：R541.74[医药卫生—心血管疾病] R540.42[医药卫生—内科学]