核素心血池显像评价心脏再同步化治疗后右心室的急性反应  

Efficacy of Equilibrium Radionuclide Angiography in Evaluating Acute Response of Right Ventricle After Cardiac Resynchronization Therapy

作　　者：陈雨[1] 张喜文[1] 徐海燕 谷阳 马树人[1] CHEN Yu;ZHANG Xiwen;XU Haiyan;GU Yang;MA Shuren(Department of Cardiology,Huai＇an First People＇s Hospital,Huai＇an223300,China)

机构地区：[1]淮安市第一人民医院心内科,江苏淮安223300

出　　处：《中国医学影像学杂志》2017年第12期907-910,共4页Chinese Journal of Medical Imaging

摘　　要：目的应用核素心血池显像(ERNA)评价慢性心力衰竭患者心脏再同步化治疗(CRT)后右心室功能及同步性的急性反应。资料与方法选取24例慢性心力衰竭患者行CRT治疗(CRT组),在治疗前及治疗后48 h内分别采集ERNA图像,计算右心室射血分数(RVEF)和右心室不同步性参数。右心室的不同步性参数定义为与R-R间期标准化的右心室相角程(RVPS)、右心室峰相位标准差(RVPSD)。选择同期20例健康志愿者为对照组。结果术后CRT组的RVEF为(35.29±3.19)%,不同步参数RVPS为(23.54±4.24)%、RVPSD为(10.33±1.74)%,较术前明显改善(P<0.05)。CRT组治疗后15例(62.5%)左心室收缩末期容积缩小≥15%,将其定义为急性反应组。急性反应组术前RVEF高于无反应组(P<0.05),而RVPS和RVPSD低于无反应组(P<0.05)。CRT急性反应组和无反应组患者术后RVPS、RVPSD均减小(P<0.05),RVEF均增加(P<0.05),两组患者右心室功能和不同步性均得到改善。结论 CRT术后即可显著改善右心室收缩功能和同步性。ERNA可以评价CRT手术前后的RVEF及右心室不同步性。Purpose To assess right ventricular function and synchronous acute response in patients with chronic cardiac failure after cardiac resynchronization therapy（CRT） using equilibrium radionuclide angiography（ERNA）. Materials and Methods Twenty-four chronic cardiac failure patients who accepted CRT were included（CRT group） and twenty healthy participants were also selected as the control group. ERNA was performed before and within 48 h after pacemaker implantation to calculate both right ventricular ejection fraction（RVEF） and RV dyssynchrony. RV dyssynchrony was defined as the standard right ventricular phase shift and right ventricular phase standard deviation（RVPS and RVPSD）. Results The postoperative RVEF, RVPS and RVPSD in CRT group were significantly improved（P〈0.05）. Fifteen patients（62.5%） were classified as acute responders, based on a reduction of at least 15% in LV end-systolic volume immediately after CRT. The baseline RVEF in responders was higher than that in nonresponders（P〈0.05）, while the RVPS and RVPSD were lower（P〈0.05）. The postoperative RVPS and RVPSD decreased（P〈0.05）, and the RVEF increased（P〈0.05） in both responders and nonresponders after pacemaker implantation, indicating that the right ventricular function and dyssynchrony in CRT group were both improved. Conclusion This study showed a significant improvement in RV ventricular systolic function and synchrony immediately after CRT. ERNA allows assessment of changes in RVEF and RV dyssynchrony before and after CRT implantation.

关 键 词：心力衰竭 心脏再同步治疗 心脏起搏 人工 放射性核素心室显像术 心室功能 右 

分 类 号：R541.6[医药卫生—心血管疾病] R817.4[医药卫生—内科学]