组织多普勒指导心脏再同步化治疗中左室电极植入的研究  

Determination of optimal left ventricular pacing site for cardiac resynchronization therapy by tissue Doppler imaging

作　　者：史浩颖[1] 汪芳[1] 金炜[1] 刘健[1] 舒先红[2] 陈灏珠[2] 刘少稳[1] 

机构地区：[1]上海交通大学第一人民医院心内科,上海200080 [2]复旦大学中山医院心内科上海市心血管病研究所,上海200032

出　　处：《上海交通大学学报（医学版）》2009年第6期641-645,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(30671999)~~

摘　　要：目的应用组织多普勒判断左室延迟收缩的部位,探索非缺血性心肌病中左室电极位于延迟收缩部位对患者心功能和左室重构的影响。方法选择33例拟行心脏再同步化治疗(CRT)的患者,术前均进行常规超声心动图和组织多普勒检查,根据收缩速度达峰时间判断左室延迟收缩的部位。术中行冠状静脉窦逆行造影,根据术前组织多普勒左室延迟收缩部位选择左室电极位置,并通过X线后前位、侧位、右前斜和左前斜位确定冠状静脉窦电极的位置,根据左室电极的位置是否与延迟收缩部位相符,将患者分为A组(n=20):电极位置和延迟收缩部位符合者;B组(n=13):电极位置和延迟收缩部位不符合者。结果术前两组患者的年龄、纽约心功能(NYHA)分级、左室收缩末容积(LVESV)、左室射血分数(LVEF)、肺动脉收缩压、QRS宽度以及左室收缩不同步指数Ts-SD均无统计学差异(P>0.05)。CRT后6月,两组患者的NYHA、LVESV和二尖瓣返流程度(MR)分级等参数变化无统计学差异(P>0.05),但A组的LVEF增加和LVESV缩小较B组显著(P<0.01)。结论在非缺血性心肌病患者中,CRT左室电极位置与延迟收缩部位符合患者的左室重构和收缩功能的改善优于不符合患者,组织多普勒可用于指导左室电极的植入。Objective To investigate whether the left ventricular delayed contraction site determined by tissue Doppler imaging might be an optimal left ventricular lead position for improved outcomes of cardiac resynchronization therapy （CRT） in patients with non-ischemic cardiomyopathy. Methods Thirty-three patients subjected to CRT were selected, and all were performed conventional ultrasound cardiography and tissue Doppler examinations before operation. The left ventricular delayed contraction site was determined according to the interval between the onset of QRS and the peak systolic velocity. Retrograde coronary venography was performed during the left ventricular delayed contraction site determined ope by ration, and the left ventricular lead site was selected according to tissue Doppler examination before operation. The coronary sinus lead site was determined under the guidance of X ray of dorsaventral, lateral, right anterior oblique and left anterior oblique positions. Patients were divided into group A（n = 20, the left ventricular lead site was in line with the delayed contraction site） and group B （n = 13, the left ventricular lead site was not in line with the delayed contraction site）. Results There was no significant difference in age, NYHA grading, left ventricular end-systolic volume（LVESV）, left ventricular ejection fraction（LVEF）, pulmonary arterial systolic pressure, QRS width and Ts-SD between the two groups before operation（P 〉 0.05）. Six months after CRT, there was no significant difference in NYHA grading, LVESV and mitral regurgitation （MR） grading between the two groups（P 〉 0.05）, while the increase in LVEF and decrease in LVESV of group A were more significant than those of group B （P 〈 0. 01）. Conclusion In patients with non-ischemic cardiomyopathy, CRT significantly improves left ventricular performance, and the more favourable outcomes are achieved in those pace at the delayed contraction site. Tissue Doppler imaging may help to guide the implant of left

关 键 词：超声心动图描记术 组织多普勒 心力衰竭 起搏 

分 类 号：R542.2[医药卫生—心血管疾病] R445.1[医药卫生—内科学]