实时三维超声心动图评价右室不同部位起搏对左心房收缩功能及同步性的远期影响  

Evaluation of long-term effects of different pacing site of right ventricle on left atrial systolic function and synchronization by real-time three-dimensional echocardiography

作　　者：唐琳梅 夏纪筑 李明星 叶强 查克岚 王文渊 彭雪莲 梁杉 邝斌 TANG Linmei;XIA Jizhu;LI Mingxing;YE Qiang;ZHA Kelan;WANG Wenyuan;PENG Xuelian;LIANG Shan;KUANG Bin(Department of Ultrasound, The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院超声科,四川泸州646000 [2]西南医科大学附属医院心内科,四川泸州646000

出　　处：《实用医学杂志》2019年第7期1151-1153,1158,共4页The Journal of Practical Medicine

基　　金：四川省科技厅支撑项目(编号:2015SZ0116)

摘　　要：目的采用实时三维超声心动图(RT-3DE)评价右心室心尖部起搏(RVAP)和右心室流出道起搏(RVOP)对左心房收缩功能及同步性的远期影响。方法回顾性分析57例植入起搏器术后2年的患者及35例正常人的RT-3DE图像,得到左心房收缩末容积(LAVmin)、左心房舒张末容积(LAVmax)、左心房收缩前容积(LAVprep)、左心房不同步指数(LASDI),计算左心房总射血分数(LATEF)、左心房主动射血分数(LAAEF),并分析LAAEF与LASDI的相关性。结果右心室流出道起搏组的LATEF和LAAEF均大于右室心尖部起搏组(P <0.001);RVOP组术后2年LASDI小于RVAP组(P <0.001);LAAEF与LASDI呈负相关(r=-0.459,P=0.000),增加的LASDI是LAAEF降低的独立预测因素。结论持续RVOP和RVAP均可导致缓慢性心律失常患者左心房收缩运动失同步化,但RVOP的不良影响较小,是较好的右室起搏部位。Objective To evaluate the long term effects of right ventricular outflow tract pacing(RVOP)and right ventricular apex pacing(RVAP)on left atrial systolic function and synchronization by real time three dimensional echocardiography(RT-3DE).Methods RT-3DE image of 57 patients with implanted pacemaker after 2 years and 35 normal subjects were analyzed retrospectively.Measuring parameters include:the left atrial end systolic volume(LAV-min),end diastolic volume(LAV-max),pre systolic volume(LAV-prep)and systolic dyssynchrony index(LASDI),then calculating the total ejection fraction(LATEF)and active ejection fraction(LAAEF)of left atrium and analyzing the correlation between LAAEF and LASDI.Results Parameter index(including LATEF and LAAEF)in the RVOP group was more than that in the RVAP group(P<0.01).The LASDI in the RVOP group with implanted pacemaker after 2 years was lower compared to the RVAP group(P<0.01).LAAEF was negatively correlated with LASDI,and increased LASDI was an independent predictor of decreased LAAEF.Conclusions Although RVOP and RVAP can lead to the dyssynchrony of left atrial contraction in patients with bradyarrhythmia,RVOP reduces the unfavourable effects and is a better right ventricular pacing site.

关 键 词：超声心动描记术 实时三维 心脏起搏器 同步性 心房功能 

分 类 号：R540.45[医药卫生—心血管疾病]