多普勒超声心动图及组织同步显像技术指导CRT的房室和室间间期优化  

Optimization of Cardiac Resynchronization Guided by Doppler Echocardiography and Tissue Synchronization Image

作　　者：张烨[1] 李治安[1] 何怡华[1] 杨娅[1] 

机构地区：[1]首都医科大学附属安贞医院超声科,北京市100029

出　　处：《中国超声医学杂志》2009年第8期758-761,共4页Chinese Journal of Ultrasound in Medicine

基　　金：国家教育部高等学校博士点科研基金（No.20060025001）和北京市优秀人才基金（No.2005ID0300619）

摘　　要：目的应用超声心动图及组织同步显像（TSI）技术评价心脏再同步化治疗（CRT）的房室（AV）和室间（VV）间期优化的临床意义。 方法接受CRT的慢性心力衰竭患者28例,其中20例进行AV间期和VV间期的优化,优化前后二尖瓣流速时间积分（MV-VTI）、二尖瓣反流面积（MR-A）、左室充盈时间（LVFT）、主动脉流速时间积分（AV-VTI）、左室12节段达峰时间标准差（12-Tp-SD）、左室12节段达峰时间最大差值（12-Tp-MAX-D）和左右心室间机械延迟（IVMD）进行对照。 结果AV间期和VV间期优化后,AV-VTI和MV-VTI较优化前增加,左室不同步参数12-Tp-SD和12-Tp-MAX-D减低,差异有统计学意义;MR-A和IVMD在调控前后无显著变化。 结论超声心动图及TSI新技术是指导CRT程序调控的首选方法,AV间期和VV间期的个性化程控对于进一步提高CRT疗效是有益的和必要的。Objective Cardiac resynchronization therapy（CRT） improves symptoms in heart failure patients with inter-and intra-ventricular dyssynchrony.Different pacing modalities produce variable activation patterns and are likely to result in different haemodynamic changes.The objective of this study was to determine whether the program optimizing of atrioventricular（AV） and interventricular（VV） delay by Doppler echocardiography and Tissue Synchronization Image（TSI） would enhance the response to CRT.Methods In 28 patients a CRT device was implanted,20 patients of which underwent AV and VV interval optimized.An optimization procedure was performed including MV-VTI,MR-A,LVFT,AV-VTI and intra-ventricular synchrony index（12-Tp-SD and 12-Tp-MAX-D）during biventricular pacing with different AV and VV delays.Results Optimal settings were defined.MV-VTI changed from 18.2±4.8 to 22.6 ± 4.2 cm,LVFT from 368±124 to 425±117 ms,AV-VTI from 16.1±5.4 to 21.4±3.9 cm,and 12-Tp-SD from 78.7±34.5 to 51.9±25.8 ms（P＆lt;0.05 for all comparisons）.Conclusions To increase efficacy pacemaker settings are optimized with echocardiography being the preferred method.Optimization of AV and VV delay provides major hemodynamic benefits and the individualized settings are necessity.

关 键 词：心脏再同步化治疗 心力衰竭 组织同步显像 程序优化 

分 类 号：R540.45[医药卫生—心血管疾病] R541.62[医药卫生—内科学]