右室不同部位起搏对左室收缩同步性及心功能影响的超声研究  

Echocardiographic assessment of left ventricular systolic synchronicity and function during pacing at variant right ventricular sites

作　　者：徐亮[1] 许迪[1] 姚静[1] 雍永宏[1] 洪牮[1] 陆美娟[1] 李相权[1] 

机构地区：[1]南京医科大学第一附属医院心内科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2011年第3期384-387,442,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金资助(30772060)

摘　　要：目的:应用实时三维超声心动图及其定量技术,分析右室不同部位起搏即刻左室收缩同步性和收缩功能的变化。方法:建立犬右室心尖部(RVA)(n=6)和右室流出道(RVOT)(n=6)起搏模型,分别采集窦性心律(SR)、RVA及RVOT起搏3种状态下经胸超声心动图实时三维全容积图(RT-3DE)。应用左室定量容积分析软件,获取左室整体及16节段容积时间曲线,分别计算16节段、12节段(中间段和基底段)、6节段(基底段)最小收缩容积到QRS波起始点时间(Tmsv)的标准差(Tmsv-SD)和最大差值的绝对值(Tmsv-Dif)及其占心动周期的百分比(Tmsv-SD%,Tmsv-Dif%)、左室舒张末容积(EDV)、左室收缩末容积(ESV)、左室每搏输出量(SV),左室射血分数(LVEF)。结果:与SR组比较,RVOT起搏组各参数均无统计学差异(P>0.05),RVA起搏组Tmsv-16SD%、Tmsv-12SD%、Tmsv-6SD%、Tmsv-16Dif%、Tmsv-12Dif%、Tmsv-6Dif%均有统计学差异(P<0.01),LVEF明显降低(P<0.05),EDV及SV减小、ESV增大,但差异无统计学意义(P>0.05)。RVA起搏组与RVOT起搏组比较Tmsv-16SD%、Tmsv-12SD%、Tmsv-6SD%、Tmsv-16Dif%、Tmsv-12Dif%、Tmsv-6Dif%均有统计学差异(P<0.05),且LVEF降低明显(P<0.05),EDV、SV降低,ESV增大,但差异无统计学意义(P>0.05)。结论:右室流出道起搏时左室收缩同步性优于右室心尖部起搏,且对左室收缩功能的影响小。实时三维超声心动图可用于评价左室心肌收缩同步性和心功能。Objective：To assess left ventricular systolic synchronicity and function with right ventricular out tract（RVOT） pacing or right ventricular apex（RVA） pacing by real-time three-dimensional echocardiography（RT-3DE）.Methods：In the acute tests of anesthetized closed-chest beagle canines,acustom designed bipolar screw-in lead was implanted using a steerable delivery catheter guided with X-ray.The bipolar leads were implanted in the right ventricular apex or the right ventricular out tract.The dogs received right ventricular pacing at the rate of（138±33） beats per minute.SIEMENS ACUSON SC2000 with 4Z1c probe was used to perform full volume RT-3DE,16-segmental volume curves were obtained by the on-line LVA software.The end-systolic volume（ESV）,end-diastolic volume（EDV）,Stroke volume（SV）,left ventricular ejection fraction（LVEF）,the standard deviation（SD）and maximal difference（Dif） of the time to point with minimal systolic volume（Tmsv）of 16 segments,12 segments（6 mid and 6 basal）and 6 segments（basal）were calculated.Tmsv-SD% and Tmsv-Dif% were used to eliminate the influence of different heart rate.Results：There was no significant difference between sinus rhythm（SR）group and RVOT group（P 〉 0.05）.After RVA pacing,Tmsv-16SD%,Tmsv-12SD%,Tmsv-6SD%,Tmsv-16Dif%,Tmsv-12Dif% and Tmsv-6Dif% were significant worsen than those in SR group（P 〈 0.01）,while LVEF was lower（P 〈 0.05）.Compared with RVOT group,Tmsv-16SD%,Tmsv-12SD%,Tmsv-6SD%,Tmsv-16Dif%,Tmsv-12Dif% and Tmsv-6Dif% were increased,and LVEF was decreased significantly（P 〈 0.05）in RVA group.Conclusion：RT-3DE is a feasible and reproducible method to quantify left ventricular synchrony and function.RVOT pacing in dogs is associated with more favorable immediate myocardial contraction and mechanical synchrony compared with RVA pacing.

关 键 词：实时三维超声心动图 同步性 心功能 起搏部位 

分 类 号：R540.45[医药卫生—心血管疾病]