不同起搏方式左心室收缩同步性超声评价的对比研究  

Comparative study on ultrasonic assessments of left ventricular systolic synchronicity under different cardiac pacing modes

作　　者：彭婷[1] 余晓梅[1] 倪显达[2] 胡元平[2] 

机构地区：[1]武汉市第一医院超声影像科,430022 [2]温州医科大学附属第一医院超声影像科

出　　处：《中华超声影像学杂志》2015年第6期481-485,共5页Chinese Journal of Ultrasonography

摘　　要：目的应用二维斑点追踪显像（2D—STI）和组织多普勒成像（TDI）技术对比分析直接希氏束起搏（directHis—bundlepacing，DHBP）与右室心尖部起搏（rightventricularapicalpacing，RVAP）时左室收缩同步性，并探讨2D-STI和TDI在评价左室收缩同步性中的应用价值。方法24例植入有DHBP和RVAP起搏方式的永久起搏器患者，分别在DHBP和RVAP状态下，采用2D-STI测量左室18节段收缩期径向应变达峰时间，计算其标准差（Trs—SD）及最大差（Trs-Dif）、左室短轴乳头肌水平的前间隔与左室后壁收缩期径向应变达峰时间的差值（Tas—post）；采用TDI测量左室12节段收缩期速度达峰时间，计算其标准差（Ts-SD）及最大差（Ts-Dif）。结果与RVAP相比，DHBP状态下各左室收缩同步性参数均明显缩短，差异有统计学意义（均P〈0．01）。DHBP时2D-STI对左室收缩同步性检出率优于TDI，RVAP时2D-STI对左室收缩不同步检出率亦优于TDI，差异均有统计学意义（均P〈0．05）。结论DHBP时左室收缩同步性及心功能均优于RVAP；RVAP可能会引起左室收缩不同步；2D-STI和TDI均能定量评价左室收缩同步性，2D-STI较TDI检出率更高。Objective To compare left ventricular （LV） synchronization of direct His-bundle pacing （DHBP） and right ventricular apical pacing （RVAP） with two-dimensional speckle tracking imaging （2D STI） and tissue Doppler imaging （TDI） ,and discuss the diagnostic value of 2D-STI and TDI in evaluation of left ventricular systolic synchronicity. Methods Twenty four patients implanted with DHBP and RVAP were observed. Conventional echocardiography examination were undergone both at the mode of DHBP or RVAP respectively. The time to peak radial strain of LV 18 segments were derived from the parasternal short-axis views by 2D-STI, then calculated the standard deviations （SD） and the maximal temporal difference of LV 18 segments （Trs-SD and Trs-Dif）,and the interval of time to peak radial strain between the anteroseptal wall and the posterior wall（Tas-post）. The time to peak systolic velocity of LV 12 segments were derived from the apical axis views by TDI. The SD and the maximal temporal difference of 12 segments （Ts-SD and Ts-Dif） were calculated as the LV dyssynchrony index. Results All the systolic synchrony parameters derived from 2D-STI and TDI were more significantly shortened in DHBP than in RVAP （all P 〈0.01）. For DHBP,the detection rate of LV synchronization was higher by 2D-STI than by TDI. For RVAP the detection rate of LV dyssynchronization was also higher by 2D-ST1 than by TDI with RVAP lead （all P〈0.05）. Conclusions DHBP is more beneficial than RVAP in LV syschronization and LV function,RVAP may induce left ventricular systolic asynchrony. Both 2D-STI and TDI can assess the LV synchronization quantitatively, but 2D-STI may be more superior on the detection rate than TDI.

关 键 词：超声心动描记术 心脏起搏 人工 心室功能 左 

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