右心室不同部位起搏时左心室总体及节段心肌收缩功能的超声评估  

Echocardiographic assessment of left ventricular global and segmental myocardial systolic function with pacing at variant right ventricular sites

作　　者：陈银花[2] 许迪[1] 陆凤翔[1] 姚静[1] 庄燕[1] 雍永宏[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,210029 [2]江苏大学附属医院心内科,镇江212001

出　　处：《中华超声影像学杂志》2010年第3期185-189,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金资助项目（30772060）

摘　　要：目的应用斑点追踪显像技术评价右心室不同部位起搏对左心室总体及节段心肌收缩功能的影响。方法获取右室间隔起搏组（9例）、右室心尖起搏组（15例）、正常对照组（13例）心尖左室长轴观、胸骨旁左室短轴观图像，测量各节段峰值纵向应变（SL）、峰值径向应变（SR），计算左室总体峰值纵向应变（GSL）、总体峰值径向应变（GSn）。结果右室心尖起搏组GSL[-（18．29±2．67）％]低于正常对照组[一（21．07±2．08）Voo]及右室间隔起搏组[-（20．54±2．29）％]，差异均具有统计学意义（P〈0．05），右室间隔起搏组与正常对照组GS。比较差异无统计学意义（P〉0．05）。而右室心尖起搏组GSRE（26．85±7．73）％]与右室间隔起搏组GSK[（28．59±6．06）％]均低于正常对照组[（36．26±9．37）％]，差异有统计学意义（P〈0．05），两起搏组间GSR差异无统计学意义（P〉O．05），但右室心尖起搏组GSR有进一步降低趋势。两起搏组邻近起搏位点的左室节段心肌S。及sR较正常对照组相应节段明显降低，但右室间隔起搏组保持了与正常对照组相似的左室内应变分布，右室心尖起搏组左室内应变分布异常。结论斑点追踪显像技术可定量评价右室不同部位起搏时左室总体及节段心肌收缩功能变化。Objective To evaluate the left ventricular （LV） global and segmental myocardial systolic function in patients with permanent DDD pacemaker implantation by speckle tracking imaging. Methods Myocardial imaging of LV apical long views and parasternal LV short axis views were performed in 9 patients with right ventricular（RV） septum pacing（RV septum group）, 15 patients with RV apex pacing（RV apex group） and 13 healthy subjects （control group）. Peak systolic longitudinal strain （SL）, peak systolic radial strain （SR） were measured, and the average of SL and SR among LV 18 segments were calculated respectively as corresponding GSL and GSR. Results The GSL [ - （ 18. 29 ±2. 67） %] of RV apex group showed significant decrease compared with RV septum group [- （20.54± 2.29）%] and control group E- （21-07 ±2. 08）%3（P 〈0.05）,while no significant difference was found between RV septum and control group. The GSR of the pacing groups were both lower than control group [（36.26 ± 9.37） % in control group, （28.59 ± 6.06） % in RV septum group, （26.85± 7.73）%in RV apex group, P d0. 05],but RV apex group showed more decrease trend. The SL and SR of the LV myocardial segments close to the pacing sites in both pacing groups showed significant decrease compared with control group,but RV septum group preserved similar LV strain distribution with control group while RV apex group showed abnormal LV strain pattern. Conclusions Speckle tracking imaging is a useful modality to evaluate global and segmental myocardial systolic function of LV with pacing at different right ventricular sites.

关 键 词：超声心动描记术 心脏起搏 人工 心室功能 左 斑点追踪显像 

分 类 号：R541.7[医药卫生—心血管疾病] R445.1[医药卫生—内科学]