压力-应变环评价左束支不同起搏模式对左室心肌做功的影响  

Pressure-strain loops technique detects the effects of different pacing modes of left bundle branch on left ventricular myocardial work

作　　者：王培伟 陈样新[1] 杨莉[1] 郑韶欣[1] 邓冰清[1] 邱琼[1] Wang Peiwei;Chen Yangxin;Yang Li;Zheng Shaoxin;Deng Bingqing;Qiu Qiong(Department of Cardiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院心血管内科,广州510120

出　　处：《中华超声影像学杂志》2022年第9期753-758,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81700359)。

摘　　要：目的利用压力-应变环技术评价左束支起搏下不同起搏模式(单/双极)对心室机械同步性及心肌做功的影响。方法选取2018年12月至2020年7月因症状性心动过缓于中山大学孙逸仙纪念医院行左束支起搏(LBBP)的患者29例为LBBP组,以同期基线条件相匹配的29例右心室起搏(RVP)患者作为RVP组。所有LBBP患者术后1周内分别程控为单极、双极起搏模式,评价心室间及左室内的机械同步性,并应用左室压力-应变环技术获得整体做功指数(GWI)、整体有效功(GCW)、整体无用功(GWW)和整体做功效率(GWE)。比较LBBP组与RVP组之间、LBBP组内不同起搏模式下的心脏机械同步性和心肌做功。结果与RVP组相比,LBBP组室内及室间机械同步性显著改善(均P<0.05);LBBP组GWI、GCW、GWE增大,GWW减小,差异有统计学意义(均P<0.05)。LBBP组单极与双极起搏对比,心室机械同步性、GWI、GCW、GWE、GWW差异无统计学意义(均P>0.05),并且提高输出电压后上述参数差异仍无统计学意义(均P>0.05)。结论与RVP患者相比,LBBP患者能保持更好的机械同步性,心肌做功效率更高;LBBP不同起搏模式对心室机械同步性及心肌做功效率无影响。Objective To evaluate the effects of different pacing modes(unipolar/bipolar)under left bundle branch pacing(LBBP)on ventricular mechanical synchrony and myocardial work using the pressure-strain loop technique.Methods Twenty-nine patients with LBBP due to symptomatic bradycardia were collected as LBBP group in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from December 2018 to July 2020.Another 29 matched patients with right ventricular pacing(RVP)during the same period were also included as a RVP group.Each LBBP patient was programmed to different pacing modes(uni-/bio-polar)within 1 week after the operation.Under each pacing mode,the inter-and intra-ventricular mechanical synchronization were evaluated.Meanwhile,the global work index(GWI),global constructive work(GCW),global wasted work(GWW),and global work efficiency(GWE)were obtained by the left ventricular pressure-strain loops technique.Results Compared with the RVP group,the mechanical synchrony in the LBBP group was significantly improved(all P<0.05).GWI,GCW,and GWE increased,while GWW decreased,and the differences were statistically significant(all P<0.05),there were no significant differences in ventricular mechanical synchronization,GWI,GCW,GWE,and GWW between unipolar and bipolar pacing in the LBBP group(all P>0.05),there were no significant differences in these parameters when increasing output voltage(all P>0.05).Conclusions LBBP induces better mechanical synchronization and higher myocardial work efficiency than RVP.Different LBBP pacing modes do not affect ventricular mechanical synchronization and myocardial work efficiency.

关 键 词：超声心动描记术 左束支起搏 压力-应变环 心肌做功 机械同步性 

分 类 号：R541.7[医药卫生—心血管疾病]