起搏位点对左心室收缩模式及功能的影响  

The influence of pacing site to left ventricular myocardial contraction patterns and function

作　　者：姚静[1] 许迪[1] 陈椿[1] 徐兢[2] 缪长青[1] 雍永宏[1] 季玲[1] 庄燕[1] 陈明龙[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科210029 [2]南京市第一医院心脏科210029

出　　处：《中华超声影像学杂志》2012年第7期553-557,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81000618）;江苏省属高校自然科学研究基金（10KJD320001）

摘　　要：目的分析右室不同位点起搏状态下左室收缩模式及功能的改变，探讨生理性起搏模式的超声评价方法。方法选择因阵发性室上性心动过速行射频消融的无器质性心脏病患者26例，于消融成功后，置人起搏导管，按照随机顺序分别起搏右房（AAI）、右室心尖部（VVI-RVA）、右室流出道（VVI-RVOT）、右室间隔部（VVI-IVS）。测量各起搏状态下：①左室收缩功能参数，包括左室扭转角度（Twist）、主动脉瓣口血流速度一时间积分（VTIao）、左室整体纵向应变（Gε）；②左室收缩模式参数，包括左室各节段收缩期纵向应变峰值（Sε）、标化纵向应变达峰时间（TPε），分别计算不同层面、不同室壁Sε、TPε值，并用曲线图分别显示Sε、TPε在不同层面及不同室壁间的分布规律，分析不同室壁Sε、TPε的相关性。结果与AAI组比较，右心室3个位点起搏组的左室收缩期Twist、VTIno、Gε绝对值均显著降低（P均〈0．01），其中右室3个位点起搏组的Gε绝对值差异有统计学意义，表现为VVHiVOT〉VVI—IVS〉VVI—RVA（P〈0．05）。与AAI组比较，右室3个位点起搏组的左心室各节段收缩期Sε、TPε的分布模式改变明显，以RVA组最为显著，而RVOT组及RVS组分布模式较接近。室壁Sε与TPε呈负相关（r=一0．51，P〈0．001）。结论与AAI起搏模式相比，右室起搏可导致左室收缩模式的改变及收缩功能的降低，其中以RVA起搏状态改变最为明显。左室纵向应变参数可用于评价不同位点起搏状态下左室收缩模式及功能改变。Objective To evaluate left ventricular(LV)myocardial contraction patterns and function when pacing in different right ventricular(RV)sites and discuss echocardiogarphic method to evaluate physiologcal pacing mode.Methods This study included 26 patients with paroxysmal supraventricular tachycardia without organic heart disease.Four pacing modes including right atrium pacing(AAI),RV apex pacing(VVI-RVA),RV septal pacing(VVI-IVS)and RV outflow tract pacing(VVI-RVOT)were performed on the patients in a random order after succussful radiofrequency ablation.The parameters measured in each pacing mode included(1)LV systolic function parameters:LV twist angle(Twist),aortic systolic velocity-time integral(VTIAo)and LV global strain(Gε)；(2)LV contracting pattern:segmental peak systolic strain(Sε),the time to peak value(TPε),and the distribution of segmental Sε,TPε in each layer or wall.The relationship between Sε,TPε of each wall was analyzed.[Results]Pacing from RV sites showed lower Twist,VTIAO and Gε than AAI mode.Gε demonstrated significant difference in three RV sites pacing mode(VVI-RVOT＞VVI-IVS＞VVI-RVA,P＜0.05).Compared with the AAI mode,the distribution of segmental Sε,TPε in the each layer or wall alerted significantly in three RV sites pacing mode,especially in VV1-RVA.The distribution pattern was similar in VVI-RVOT and VVI-IVS.Furthermore,the wall Sε collated negtively with wall TPε(r =-0.51,P＜0.001).[Conclusions]Compared with AAI mode,RV pacing,especially the VVI-RVA induced the alternation of LV contraction patterns and reduction of systolic function.Longitudinal strain parameters can be used to assess the myocardial contraction patterns and function in different pacing mode.

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]