四维斑点追踪联合超声心动图分层应变技术评价不同部位起搏对左心室功能及同步性的影响  

Assessment of left ventricular function and synchronicity after pacemaker implantation in different locations using four-dimensional speckle tracking imaging and three-layer speckle tracking echocardiography

作　　者：李慧 顾敏 胡奕然 齐红霞 刘偈 王浩[1] Li Hui;Gu Min;Hu Yiran;Qi Hongxia;Liu Jie;Wang Hao(Department of Echocardiography,National Center for Cardiovascular Disease,Fuwai Hospital,Beijing 100037,China;Center of Arrhythmia,National Center for Cardiovascular Disease,Fuwai Hospital,Beijing 100037,China)

机构地区：[1]国家心血管病中心,中国医学科学院阜外医院超声影像中心,北京100037 [2]国家心血管病中心,中国医学科学院阜外医院心律失常中心,北京100037

出　　处：《中华医学超声杂志（电子版）》2021年第2期135-142,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：中央高校基本科研业务费专项资金资助(3332018051)。

摘　　要：目的应用四维斑点追踪显像(4D-STI)及超声心动图分层应变技术评价右心室不同部位起搏器植入术后左心室收缩功能及同步性。方法选取2018年12月至2019年10月于中国医学科学院阜外医院住院的双腔起搏器植入术患者100例,并根据起搏部位不同将其分为右心室心尖组(RVAP组)35例、右心室间隔组(RVSP组)35例、希氏束组(HBP组)30例。术前及术后6个月应用超声分层应变技术分析左心室3层心肌(心内膜下、中层和心外膜下心肌)纵向应变的变化,应用峰值应变离散(PSD)评估左心室同步性变化;采用4D-STI获得左心室整体纵向应变(GLS)、环周应变(GCS)、径向应变(GRS)、面积应变(GAS)。并对术前及术后3组间及组内参数进行比较分析。结果术后6个月随访,RVAP组PSD较术前明显延长(t=-4.502,P=0.004);RVSP及HBP组PSD均较术前缩短,HBP组较术前缩短更加显著,差异有统计学意义(t=-2.363,P=0.04);3组间术后6个月PSD比较,差异有统计学意义(F=12.261,P<0.001)。术后6个月,RVAP组GLS-epi与术前比较差异有统计学意义(t=-2.501,P=0.046);RVSP及HBP组GLS-epi与术前相比降低不显著;3组间术后6个月GLS-epi比较,差异有统计学意义(F=6.786,P=0.034)。术后6个月RVAP组GLS、GCS、GRS、GAS均较术前降低,其中GCS、GRS、GAS差异均有统计学意义(P=0.049、0.014、0.037)。术后6个月,HBP组GLS、GAS、GRS明显优于RVAP组,差异均有统计学意义(P<0.001、=0.002、=0.001);HBP组GLS、 GAS优于RVSP组,差异均有统计学意义(P=0.01、 0.043)。结论 4D-STI联合超声分层应变技术可用于早期评价不同部位起搏术后左心室功能及同步性。HBP较RVAP及RVSP在改善左心室机械同步性方面更具优势;RVAP术后早期即出现左心室收缩功能减低,HBP及RVSP对左心室收缩功能无不良影响。Objective To evaluate left ventricular(LV)systolic function and synchronicity after pacemaker implantation in different locations of the right ventricle by four-dimensional speckle tracking imaging(4 D-STI)and three-layer speckle tracking echocardiography.Methods One hundred patients who received permanent cardiac dual-cavity pacemaker implantation at Beijing Fuwai Hospital from December2018 to October 2019 were enrolled and divided into a right ventricle apex pacing(RVAP)group,right ventricular septum pacing(RVSP)group,and His bundle pacing(HBP)group based on the implantation location.Three-layer speckle tracking echocardiography was conducted to analyze LV three-layer myocardium(endocardial,mid,and epicardial layers)changes in longitudinal strain(LS),and peak strain dispersion(PSD)was used to evaluate LV synchronicity.4 D-STI was taken to obtain GLS,global circumferential strain(GCS),global radial strain(GRS),and global area strain(GAS).Preoperative and postoperative changes of the above indicators were compared between and within the three groups.Results Six months after surgery,PSD in the RVAP group was significantly longer than that before surgery(t=-4.502,P=0.004).PSD in both the RVSP and HBP groups was shorter than that before surgery,and the change was more significant in the HBP group(t=-2.363,P=0.04);the difference in PSD among the three groups was statistically significant(F=12.261,P<0.001).GLS-epi in the RVAP group differed significantly between before and after surgery(t=-2.501,P=0.046),and the difference among the three groups was statistically significant(F=6.786,P=0.034).Six months after surgery,GLS,GCS,GRS,and GAS in the RVAP group were all lower than those before surgery,and the differences in GCS,GRS,and GAS were statistically significant(P=0.049,0.014,0.037).GLS(P<0.001),GAS(P=0.002),and GRS(P=0.001)in the HBP group were significantly better than those in the RVAP group.GLS(P=0.01)and GAS(P=0.043)in the HBP group were significantly better than those in the RVAP group.Conclusion 4 D-STI and thr

关 键 词：心脏起搏 超声心动图 斑点追踪成像 心室功能 左 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]