二维斑点追踪成像评价左束支起搏左心室激动顺序与同步性  

Evaluation of left ventricular activation sequence and intraventricular synchronization in patients with left bundle branch pacing by two-dimensional speckle tracking imaging

作　　者：王秀秀 严霜霜 邓晓奇 熊峰 Wang Xiuxiu;Yan Shuangshuang;Deng Xiaoqi;Xiong Feng(Department of Cardiology,Cardiovascular Institute of Chengdu,The Affiliated Hospital of Southwest Jiaotong University,The Third People's Hospital of Chengdu,Chengdu 610031,China)

机构地区：[1]西南交通大学附属医院、成都市第三人民医院心内科、成都市心血管病研究所,成都610031

出　　处：《中华医学超声杂志（电子版）》2023年第4期404-410,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：四川省卫生健康委科技项目(20PJ210)。

摘　　要：目的应用二维斑点追踪成像(2D-STI)对左束支起搏(LBBP)左心室激动顺序进行间接标测,并分析室内同步性。方法选取2020年7月至2020年12月于成都市第三人民医院成功进行LBBP的患者22例(LBBP组)和右心室流出道起搏(RVOTP)患者16例(RVOTP组),2组患者均于术后3个月随诊复查超声心动图。另选取健康成年人17例作为对照组。采用2D-STI生成应变-时间曲线,收缩早期正向曲线收缩起始时间(OTS)为心电图R波峰至正向应变达峰时间;记录负向曲线第二帧时的应变绝对值(Sn),以Sn中取值最大者(S)和第二帧时间(T)计算收缩早期应变速度(V=S/T),OTS=T-Sn/V。采用整体及各水平纵向应变达峰时间标准差(Tp-SD)作为室内同步性参数。结果正常组QRS时限最短(95.35±10.04)ms,LBBP组次之(113.41±11.46)ms,RVOTP组明显延长(144.94±13.03)ms,差异均有统计学意义(P均<0.05)。各水平OTS相比较,仅RVOTP组侧壁心尖段与正常组差异有统计学意义[(29.56±13.33)ms vs(19.53±15.02)ms,P<0.05]。各组最早激动节段的OTS值以正常组最小(10.76±9.67)ms,LBBP组次之(14.45±7.30)ms,RVOTP组最大(17.19±19.43)ms。各组最早与最晚激动节段OTS之差均在40 ms以内。RVOTP组整体、中间段Tp-SD与LBBP组、正常组相比差异均有统计学意义(P均<0.05),而基底段、心尖段Tp-SD比较差异均无统计学意义(P均>0.05);LBBP组各水平Tp-SD与正常组比较差异均无统计学意义(P均>0.05)。结论2D-STI可无创地标测左心室激动顺序,有助于发现激动顺序的异常改变;LBBP术后早期可维持相对正常的左心室激动顺序和室内同步性,且同步性明显优于RVOTP。Objective To map the left ventricular activation sequence indirectly and analyze the intraventricular synchronization in patients with left bundle branch pacing(LBBP)by two-dimensional speckle tracking imaging(2D-STI).Methods Twenty-two patients with LBBP and 16 patients with right ventricular outflow tract pacing(RVOTP)in Chengdu Third People's Hospital from July 2020 to December 2020 were enrolled,and 17 healthy adults were selected as a control group.Strain-time curves were generated by 2D-STI.Onset time of systole(OTS)of positive curves was the time from the R wave to the positive peak strain.For negative curves,the largest value(S)of absolute strain values(Sn)at the second frame and the second frame time(T)were used to calculate the strain rate(V=S/T),and OTS was calculated as T-Sn/V.The standard deviation of peak time(Tp-SD)was used as the intraventricular synchronization parameter.Results QRS duration was the shortest in the control group[(95.35±10.04)ms],followed by the LBBP group[(113.41±11.46)ms],and it was significantly prolonged in the RVOTP group[(144.94±13.03)ms];the difference between any two groups was statistically significant(P<0.05).When comparing OTS at all levels,only OTS in the apical segment of lateral wall in the RVOTP group was significantly different from that in the control group[(29.56±13.33)ms vs(19.53±15.02)ms,P<0.05].OTS of the earliest excited segment was the lowest in the control group[(10.76±9.67)ms],followed by the LBBP group[(14.45±7.30)ms]and RVOTP group[(17.19±19.43)ms].The difference of OTS between the earliest and the latest excited segments in each group was less than 40 ms.Compared with the LBBP group and the control group,Tp-SD in the global and middle segment was statistically different in the RVOTP group(P<0.05),but there was no significant difference in Tp-SD in the basal segment and apical segment(P>0.05).There was no significant difference in Tp-SD between the LBBP group and the control group(P<0.05).Conclusion 2D-STI can noninvasively map the left ventricul

关 键 词：斑点追踪超声心动图 应变分析 左束支起搏 心室激动顺序 室内同步性 

分 类 号：R541.7[医药卫生—心血管疾病]