实时三维超声心动图联合斑点追踪技术评价不同部位起搏对右室功能的影响  

Assessment of Right Ventricular Function after Pacemaker Implantation on Different Locations by Real-time Three-dimensional Echocardiography Combined with Speckle Tracking Imaging

作　　者：李慧[1] 胡奕然 顾敏[2] 刘偈 齐红霞 王江涛 逄坤静[1] LI Hui;HU Yi-ran;GU Min;LIU Jie;QI Hong-xia;WANG Jiang-tao;PANG Kun-jing(Department of Echocardiography,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037;Center of Arrhythmia,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037;GE Healthcare(Beijing),China)

机构地区：[1]中国医学科学院,北京协和医学院国家心血管病中,心阜外医院超声影像中心,北京市100037 [2]中国医学科学院,北京协和医学院国家心血管病中,心阜外医院心律失常中心,北京市100037 [3]通用电气医疗心血管超声临床科研部

出　　处：《中国分子心脏病学杂志》2020年第4期3454-3458,共5页Molecular Cardiology of China

摘　　要：目的应用实时三维超声心动图联合斑点追踪技术研究不同部位起搏对右室功能的影响。方法选取2018年12月至2019年6月行双腔起搏器植入术患者90例,并根据起搏部位不同分为右室心尖组(RVAP组)、右室间隔组(RVSP组)、希氏束组(HBP组)。术前及术后6个月分别测量二维超声参数,同时采集实时三维超声心动图像并分析右室舒张末期容积、右室收缩末期容积、右室射血分数,应用斑点追踪技术获得右室间隔纵向应变及右室游离壁纵向应变。比较三组间及组内上述指标术前及术后变化。结果术后6个月组间三尖瓣环e’有统计学差异(P=0.04),RVAP组明显小于其他两组,且RVAP组术后6个月e’及a’均较术前明显减低(P<0.05)。术前及术后三组间右室舒张末期容积、右室收缩末期容积、右室射血分数无明显统计学差异(P>0.05)。术后6个月组间应变指标有明显统计学差异(P=0.01,P=0.02),RVAP组明显低于RVSP组及HBP组。结论实时三维超声心动图联合斑点追踪技术是评估不同部位起搏方式术后早期右室功能的可靠方法。RVSP及HBP术后右室功能优于RVAP,为安全、有效的起搏方式。Objective To evaluate right ventricular function after pacemaker implantation on different locations by real-time threedimensional echocardiography(RT-3DE)combined with speckle tracking imaging(STI).Methods Ninety patients who received permanent cardiac dual-cavity pacemaker implantation from December 2018 to June 2019 were enrolled and divided into right ventricle apex pacing(RVAP)group,right ventricular septum pacing(RVSP)group and His bundle pacing(HBP)group in line with different implantation parts.2D conventional parameters,RT-3DE and STI were taken to obtain right ventricular end-diastolic(RVEDV),end-systolic volume(RVESV),RV ejection fraction(RVEF)and longitudinal strain of the patients before and six months after the surgery.Preoperative and postoperative changes of the above indicators were compared between and within the three groups.Results There was a significant difference of e’in the tricuspid annulus six months after the operation between the groups(P=0.04).RVAP group was significantly smaller than the other two groups,and both e’and a’in the or VAP group were significantly reduced six months after the operation(P<0.05).There was no significant difference in RVEDD,RVESD,RVEF between the three groups before and after surgery(P>0.05).There were significant differences in strain index between the groups 6 months after the operation(P=0.01,P=0.02),and RVAP group was significantly lower than RVSP and HBP groups.Conclusion RT-3DE combined with STI can be used for quantitative analysis of right ventricular function during short-term follow-up.RVSP and HBP are superior to the RVAP group in right ventricular function after surgery,and thay are safe and effective pacing methods.

关 键 词：心脏起搏 超声心动图 实时三维 斑点追踪显像 右室功能 

分 类 号：R540.45[医药卫生—心血管疾病] R541.7[医药卫生—内科学]