实时三维超声心动图评价左束支区域起搏与右心室间隔部起搏术后右心室功能及比较  

Comparison and Assessment of Right Ventricular Function after Left Bundle Branch Area Pacing and Right Ventricular Septum Pacing by Real-time Three-dimensional Echocardiography

作　　者：陶瑾 朱浩杰 李慧 樊晓寒 王浩[1] TAO Jin;ZHU Haojie;LI Hui;FAN Xiaohan;WANG Hao(Department of Echocardiography,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Center of Arrhythmia,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

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

出　　处：《中国分子心脏病学杂志》2022年第6期5010-5016,共7页Molecular Cardiology of China

基　　金：国家自然科学基金(81800263);阜外医院青年科学基金项目(2022-FWQN05)。

摘　　要：目的 应用实时三维超声心动图评价左束支区域起搏(LBBaP)和右心室间隔部起搏(RVSP)术后右心室功能,并进行比较。方法 回顾性分析2020年11月至2022年1月行永久性心脏起搏器植入术的95例患者的临床资料,其中50例患者采用LBBaP(LBBaP组),45例患者采用RVSP(RVSP组)。所有患者术前及术后6个月均进行二维和实时三维超声心动图检查,获取图像并评估右心室大小及功能参数,比较手术前后两组患者上述参数的变化。结果 术前两组患者右心室大小及功能参数差异均无统计学意义(P> 0.05)。术后6个月RVSP组患者右心室舒张末期容积较术前增加,且差异有统计学意义(P <0.05);反映右心室功能的三尖瓣环收缩期位移、右心室射血分数、右心室间隔纵向应变、游离壁纵向应变及三尖瓣环舒张早期运动速度(e’)也均较术前降低,且差异均有统计学意义(P <0.05)。术后6个月RVSP组患者三尖瓣环e’较LBBaP组患者降低,且差异有统计学意义(P <0.01)。然而,LBBaP组患者右心室大小及功能参数与术前比较差异均无统计学意义(P> 0.05)。结论 应用实时三维超声心动图评价不同部位起搏方式术后右心室功能具有重要的临床价值。RVSP对患者术后右心室功能有一定影响,而LBBaP则未见显著影响,安全性及有效性更高。Objective To compare the effect of left bundle branch area pacing(LBBaP) and right ventricular septal pacing(RVSP) method on right ventricular function by real-time three-dimensional echocardiography.Methods Patients who underwent permanent pacemaker implantation from November 2020 to January 2022 were enrolled,and were divided into the LBBaP group and the RVSP group according to the implantation site.Baseline characteristics were compared between groups.Both twodimensional and real-time three-dimensional echocardiography were performed preoperatively and 6-month postoperatively,and changes in the above parameters were compared within and between groups.Results No significant differences in baseline characteristics were found.No significant changes in right ventricular dimensional and functional parameters were detected between groups before the surgery.The right ventricular end-diastolic volume in the RVSP group after the surgery increased significantly compared with that before the surgery.Tricuspid annular plane systolic excursion,right ventricular ejection fraction,right ventricular septum longitudinal strain,right ventricular free-wall longitudinal strain and tricuspid annular early diastolic velocity(e’) also decreased significantly in the RVSP group after the surgery.In addition,e’ in the RVSP group was lower than that in the LBBaP group after the surgery.However,there was no significant difference in right ventricular dimensional and functional parameters in the LBBaP group after surgery compared with baseline.Conclusions The evaluation of right ventricular function after different pacing methods based on real-time three-dimensional echocardiography is of great clinical significance.The RVSP method affects right ventricular function to some degree,while no significant effect on right ventricular function was found of the LBBaP method,indicating greater safety and efficacy.

关 键 词：超声心动图 右心室功能 右心室间隔部起搏 左束支区域起搏 

分 类 号：R654.2[医药卫生—外科学]