超声心动图评价左束支区域起搏与右心室起搏对左心室收缩同步性的影响  

Ultrasonic Evaluation of the Influence of Left Bundle Branch Area Pacing and Right Ventricular Pacing on Left Ventricular Systolic Synchronism

作　　者：宋爱萍[1] 任骋[2] 徐心纯 许红[1] SONG Aiping;REN Cheng;XU Xinchun;XU Hong(Department of Ultrasound,Zhangjiagang Hospital Affiliated to Soochow University,Suzhou 215600,China)

机构地区：[1]苏州大学附属张家港医院超声科,江苏苏州215600 [2]苏州大学附属张家港医院心内科,江苏苏州215600

出　　处：《中国医学影像学杂志》2021年第2期152-157,共6页Chinese Journal of Medical Imaging

摘　　要：目的应用二维斑点追踪成像(2D-STI)及组织多普勒成像(TDI)对比分析左束支区域起搏(LBBP)与右心室起搏术后左心室收缩同步性,并研究两者在检测左心室收缩同步性中的应用价值。资料与方法67例有心室起搏指征的患者分成两组,36例接受LBBP治疗,31例接受右心室起搏(RVP)治疗,所有患者于术前、术后3个月分别行12导联心电图和常规超声心动图检查,术后3个月应用2D-STI获得左心室17节段收缩期纵向应变达峰时间最大差值(Tls-Dif)及峰值应变离散度(PSD)、左心室乳头肌水平6节段径向应变达峰时间标准差(Trs-SD)及前间隔与左心室后壁径向应变达峰时间差值(Taspost);采用TDI获得左心室12节段收缩期速度达峰时间标准差(Ts-SD)及最大差值(Ts-Dif)。结果与RVP组比较,LBBP组左心室收缩同步性参数Tls-Dif、PSD、Trs-SD、Tas-post、Ts-SD及Ts-Dif均较短(P均<0.05)。2D-STI对LBBP起搏状态下左心室收缩同步性的检出率为72%(26/36),高于TDI的58%(21/36);RVP起搏状态下2D-STI对其左心室收缩不同步的检出率为84%(26/31),高于TDI的65%(20/31),差异均有统计学意义(P均<0.05)。结论LBBP起搏状态下左心室收缩同步性优于RVP;2D-STI与TDI均可定量评价左心室收缩同步性,2D-STI对左心室收缩同步性的检出率高于TDI,且操作简捷方便,重复性较好,值得临床推广。Purpose To compare the left ventricular systolic synchronism after left bundle branch area pacing(LBBP)and right ventricular pacing by using two-dimensional speckle-tracking imaging(2D-STI)and tissue Doppler imaging(TDI),and to discuss the diagnostic value of the above two methods in detecting left ventricular systolic synchronism.Materials and Methods Sixty-seven patients with indications of ventricular pacing were divided into two groups:36 patients received LBBP pacing therapy,the other 31 patients received RVP pacing therapy.12-lead electrocardiogram and routine echocardiography were performed in all patients before pacemake implantation and three months after pacemaker implantation,and the left ventricular systolic synchronism was evaluated three months after pacemaker implantation by 2D-STI and TDI.The maximal temporal differences of the time to peak systolic longitudinal strain(Tls-Dif)and the peak strain dispersion(PSD)of left ventricular 17 segments were obtained by 2D-STI.In addition,the standard deviations of the time to peak systolic radial strain(Trs-SD)and the time difference between the anterior-septal and posterior wall peak radial strain(Tas-post)were obtained at the papillary muscles level by 2D-STI from the left ventricular short-axis view.The time to peak systolic velocity,the standard deviation of the time to peak systolic velocity(Ts-SD)and the maximal temporal differences of the time to peak systolic velocity(Ts-Dif)of left ventricular 12 segments were obtained by TDI.Results Compared with the RVP group,all the left ventricular systolic synchrony parameters Tls-Dif,PSD,Trs-SD,Taspost,Ts-SD and Ts-Dif were significantly shortened in LBBP group(all P<0.05).The detection rate of 2D-STI for left ventricular systolic synchrony in LBBP pacing was 72%(26/36)higher than that in TDI(58%,21/36),and the detection rate of 2D-STI for left ventricular systolic dyssynchrony in RVP pacing was 84%(26/31)higher than that in TDI(65%,20/31),and the difference was statistically significant(all P<0.05).Conclusio

关 键 词：超声心动描记术 多普勒 彩色 心脏起搏 人工 心室功能 左 心肌收缩 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.7[医药卫生—诊断学]