使用心肌机械运动顺序间接标测左室电激动顺序的临床研究  

Mapping of left ventricular electrical activation with myocardial electromechanical sequence in human

作　　者：胡敏[1] 江成璠[1] 王素霞[1] 吴乐[1] 洪菲[1] 刘超美[1] 

机构地区：[1]黄山市人民医院功能科,安徽黄山245000

出　　处：《中国心脏起搏与心电生理杂志》2016年第3期229-233,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探索利用超声心动图二维斑点追踪(2DSTE)应变成像技术无创性间接标测左心室(LV)电激动顺序的方法。方法选择健康成人12例(N组)、QRS波正常但ST-T异常者18例(R组)及左束支传导阻滞者26例(D组)。使用2DSTE分析LV3个标准心尖切面长轴应变,对于存在收缩早期正向应变的节段以心电信号R波峰为起点测量正向应变达峰时间为收缩起始时间(OTS),对于收缩早期为负向应变的所有节段测量第二帧时的应变值(S_n),以S_n的最大绝对值(S)计算2帧间(时间为T)的应变速率(-S/T),通过公式OTS_n=T-S_n/(-S/T)计算OTS。使用17节段模型的OTS表示LV机械激动顺序(MAS),并以17节段OTS的平均值和标准差表示LV全局收缩起始时间(OTSG)和离散度(OTSSD)。比较MAS与公认的心内膜面电激动顺序(EAS)的一致性,并比较3组间OTSG、OTSSD及相应节段OTS的差异性。结果 N组LV中段较早收缩,其中下壁、侧壁和前壁中段最早,心尖段略迟,基底段更迟,尤以后壁基底段最迟。R组与N组接近。D组以前间隔中段最早,冲动沿室壁圆周方向或心尖方向朝LV游离壁扩布,侧壁及后壁中间段和基底段均较迟激动。3组MAS均与EAS大体一致。N组与R组OTS_G、OTS_(SD)及相应节段OTS均无统计学差异(P均>0.05),D组OTS_G和OTS_(SD)均大于N组与R组,差异有统计学意义(P均<0.05),下壁中段OTS较N组显著延迟(P<0.05)。结论确切测算节段心肌收缩起始时间可间接地无创性地标测LV电激动顺序。Objective To explore a noninvasive method to map left ventricular （LV） electrical activation sequence for regional myocardial strain by 2D speckle tracking echocardiography （2DSTE）. Methods There were 12 health adult in group N, 18 patients with abnormal ST-T and normal QRS in group R, 26 left bundle branch block （LBBB） patients in group D. 2DSTE was used to analyze LV segment longitudinal strain in 3 standard apical views. The OTSs of 17-segment model were analyzed from the time-strain data by professional computer software. The protocol of OTS calculation was： if segments exist positive strain in the early systolic, the time to peak positive strain from the tip of R wave was admitted as the OTS, otherwise, measured the strain values （Sn） of all negative strain segments at the moment of 2nd frame, the maximum value of the absolute Sn was S, the time between the 2 frames was T, the assumed myocardial strain rate is - S/T, then OTSn ： T - Sn/ （-S/T） was the OTS of the nth segment. The 17-segment model＇s OTSs were considered to be LV mechanical activation sequence （MAS）, and the mean and standard deviation of these OTSs to be LV global activation time （OTSG） and dispersion （OTSsD）. Com- pared the consistency of MAS to classical endocardial electrical activation sequence （EAS）, and the difference of OTSG, OTSsD and OTS of each segment in 3 groups. Results In group N, mid inferior, anterolateral and anterior were the earliest excited segments. LV middle level usually actived earlier, then apical and basal level, the excitation spreaded rapidly, nearly complete LV in 30 ms, except the latest basal inferolateral. The group R was similar with group N. In group D, the excitement spreaded slowly from mid anteroseptal to LV free wall, and from apical segment to basal . The mid and basal anterolateral and inferolateral were lateset. There were broadly consistent sequences between MAS and EAS. The OTSG, OTSsD and OTSs of each segment had no significant difference between group N and

关 键 词：心脏影像学 超声心动图 心脏电生理 左室 应变 二维斑点追踪 心电图 

分 类 号：R331.38[医药卫生—人体生理学] R540.41[医药卫生—基础医学]