二维斑点追踪成像评价右室不同部位起搏对左室功能及同步性的影响  

Impact of pacing from different right ventricularpacing siteson left ventricular function andsynchronism assessed by two-dimensional speckle tracking imaging

作　　者：安亚平[1] 俞杉[1] 郑志伟 陈亚宁[1] 吴强[1] AN Yaping;YU Sha;ZHENG Zhiwei;CHEN Yaning;WU Qiang(Department of Cardiology,Guizhou Provincial People′s Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院心内科,贵阳550002

出　　处：《实用医学杂志》2019年第10期1659-1663,共5页The Journal of Practical Medicine

基　　金：贵州省科技基金重点项目黔科合基础(编号:2016[1410]);贵州省卫生计生委科学技术基金(编号:GZWKJ2014-1-047)

摘　　要：目的运用二维斑点追踪成像技术(2D-STI)评价右室不同部位起搏对左室心功能及同步性的影响。方法将符合埋藏式心脏起搏器植入适应证的房室传导阻滞患者随机分为右室心尖部(RVA)起搏30例,右室流出道(RVOT)起搏26例。运用2D-STI测量患者术前、术后3、12个月的整体及各节段左室心肌纵向应变(LS)、左心室前间壁和后壁的最大收缩期达峰值径向应变的时间差(TAS-POST),评价右室不同起搏位点对左室功能及同步性的影响。结果 (1)收缩功能:两组术后3、12个月整体纵向应变(GLS)及左室射血分数(LVEF)均小于术前,其中术后12个月GLS分别较同组内术前、术后3个月明显下降(P <0.05),且RVA组术后12个月GLS较RVOT组明显下降(P <0.05)。两组内术后12个月与术后3个月分别相比较,各个节段LS均降低,其中RVA组有7个节段差异具有统计学意义(P <0.05),而RVOT组有5个节段差异具有统计学意义(P <0.05)。(2)同步性:两组术后TAS-POST均较术前延长,呈逐渐增加趋势,且术后同时期RVA组较RVOT组明显延长(P <0.05)。结论右室两种不同起搏位点对左室内收缩同步性及心功能均有不良影响;RVOT起搏对心室电-机械活动及同步性的影响较RVA起搏小,可能有益于延缓长期起搏后心脏结构及心功能的恶化。Objective To explore the effects of pacing from different right ventricular(RV)pacing siteson left ventricular(LV) function andsynchronism by two dimensionalspeckle tracking( 2D-STI). Methods Patients with atrioventricular block who met the implantation indication of implantable pacemaker were randomly divided into 30 patients with RVApacingand 26 patients with RVOTpacing. Three and twelve months after pacemaker implantation,the global and segmental myocardial longitudinal strains( LS) of left ventricle,and absolute differences in time to peak radial strain for the anteroseptal wall versus the posterior wall of left ventricle( TAS-POST)w ere measured by 2D-STI. Results (1) Systolic function:GLS and LVEF value atthe 3^rd and 12^th month of both groups were smaller than those before pacemaker implantation,and there were statistically significant differences between GLS atthe 12^th month andthat before the implantation and at the 3^rd month after pacemaker operation in different groups(P < 0.05), andGLS atthe 12^th month in RVA group was obviously smaller than thatof RVOT group(P < 0.05). In each group,each segmental LS atthe 12^th month afterpacemaker implantation declined when compared to that at the 3^rd month after pacemaker implantation,and 7 LS values in RVA group showed statistically significantdifferences (P < 0.05), while 5 LS values in RVOT group demonstrated statistically significant differences(P < 0.05)(. 2) Synchronism: TAS-POST values of both groups after pacemaker implantation were longer thanthose before pacemaker implantation,while the post operative TAS-POST value of RVA group during the same period was obviously longer than that of RVOT group(P < 0.05). Conclusion Both different pacing sites of RV have adverse effects on the systolic synchrony and cardiac function of LV.From the long term trend of development,ROVT pacing fulfills a more physiological depolarization pattern and is good for keeping systolic anddiastolic synchrony of LV.

关 键 词：斑点追踪显像 右室流出道 右室心尖部 心功能 室内同步性 

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