起搏位点对左心室收缩功能及径向应变的影响  

Impact of pacing location on left ventricular function and radial strain

作　　者：葛贝贝 姚静[1] 许迪[1] 陈椿[1] 张艳娟[1] 李明霞 王小贤 陈燕[1] 沈艳[1] 缪长青[1,2] GE Beibei;YAO Jing;XU Di;CHEN Chun;ZHANG Yanjuan;LI Mingxia;WANG Xiaoxian;CHEN Yan;SHEN Yan;MIAO Changqing(Department of Cardiology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Cardiology,Jiangyin People′s Hospital,Jiangsu Province)

机构地区：[1]南京医科大学第一附属医院心内科,南京210029 [2]江苏省江阴市人民医院心内科

出　　处：《南通大学学报（医学版）》2021年第6期515-518,共4页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金资助项目(81571691,81771844)。

摘　　要：目的:评估右心室不同起搏位点状态下左心室收缩功能及左心室径向应变参数的改变。方法:选择24例阵发性室上性心动过速的无器质性心脏病患者,于射频消融手术成功后置入起搏导管,按照随机顺序分别行右心房起搏(right atrial pacing,RAP)、右心室心尖部起搏(right ventricular apex pacing,RVAP)、右心室流出道起搏(right ventricular outflow tract pacing,RVOP)、右心室间隔部起搏(right ventricular septal pacing,RVSP)。应用经胸超声心动图技术获取不同右心室起搏状态下左心室收缩功能参数和不同节段心肌径向应变峰值参数。结果:与RAP相比,右心室3个位点起搏组的左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室每搏输出量(stroke volume,SV)均显著降低(均P<0.01)。RVAP模式下,基底段及中间段各室壁收缩期径向应变峰值均较RAP起搏时降低,除基底段前室间隔及前壁外均具有统计学意义(均P<0.05)。RVOP模式下,各室壁基底段及中间段收缩期径向应变峰值均较RAP起搏时降低,其中前室间隔中间段水平差异有统计学意义(P<0.05),基底段后室间隔、侧壁、前室间隔、前壁差异均有统计学意义(均P<0.05)。RVSP模式下,基底段及中间段各室壁收缩期径向应变峰值均较RAP时降低,但差异无统计学意义(P>0.05)。3种起搏模式下心尖段收缩期径向应变峰值与RAP比较差异均无统计学意义(均P>0.05)。结论:相较于RAP模式,右心室起搏均可导致左心室收缩功能降低,其中RVAP对左心室收缩功能改变最为显著。应用左心室径向应变参数可评价不同位点起搏状态下左心室收缩功能改变。Objective:To evaluate the changes of left ventricular systolic function and radial strain parameters in different pacemaker sites of right ventricle.Methods:This study include 24 patients with paroxyamal supraventricular tachcardia without organic heart disease.Four pacing modes including right atrial pacing(RAP),right ventricular apex pacing(RVAP),right ventricular outflow tract pacing(RVOP)and right ventricular septal pacing(RVSP)were performed on the patients in a random order after successful radiofrequency ablation.The parameters of left ventricular systolic function and segments systolic radial strain peak were obtained by transthoracic echocardiography in four different pacing modes.Results:Compared with the RAP mode,the left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF)and left ventricular stroke volume(SV)in the right ventricular pacing modes were significantly reduced(P<0.01).The systolic radial strain peak of RVAP in the basal segment and the middle segment was lower than that in the RAP.Except for the anterior ventricular septum and the anterior wall in the basal segment,the strain was statistically significant(P<0.05).In the RVOP,the systolic radial strain peak in all the basal and the middle segment was lower than that in the RAP,among which the level of anterior ventricular septum in the middle segment was statistically significant(P<0.05),and there were significant differences in posterior ventricular septum,lateral wall,anterior ventricular septum and anterior wall in the basal segment(P<0.05).The systolic radial strain peak of RVSP,the radial peak strain in the basal and middle segment was lower than that in RAP(P>0.05).No significant difference was found of the apical segments peak systolic radial strain between RAP and right ventricular pacing modes(P>0.05).Conclusions:Compared with RAP mode,right ventricular pacing,especially the RVAP induced the reduction of left ventricular systolic function.The radial strain parameter can be used to assess the change of l

关 键 词：超声心动描记术 心脏起搏 左心室功能 斑点追踪显像 

分 类 号：R541.71[医药卫生—心血管疾病]