心脏再同步化治疗中期患者关闭左心室起搏对左室血液流场及收缩功能的影响  

The Influence on Left Ventricular Systolic Function and Blood Flow Field in Mid-term Cardiac Resynchronization Therapy Patients with Closed Left Ventricular Pacing

作　　者：纳丽莎[1] 叶晶晶[1] 刘丽文[2] 周丽 王芳 沈敏[3] 

机构地区：[1]宁夏医科大学总医院心脏中心功能检查部超声心动图,银川市750004 [2]第四军医大学西京医院超声诊断科 [3]第四军医大学西京医院心脏内科导管室

出　　处：《中国超声医学杂志》2015年第6期565-568,共4页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金(No.81170305);军队基金(No.CWSIIJ056);2012年陕西省科技计划项目(No.2012K15-02-03)

摘　　要：目的应用血流向量成像(VFM)技术评价心脏再同步化治疗(CRT)中期患者三腔起搏与关闭左室起搏后的两腔起搏左室收缩期血液流场演变以及收缩功能变化情况。方法 CRT术后6~12个月有反应的患者17例,关闭左心室起搏,分别于三腔和两腔起搏时行常规超声心动图检查。利用VFM软件采集左室内血流向量图像,观察其演变特征。结果与三腔起搏比较,关闭左心室起搏器30min后患者的MRV增多,LVDp/Dtmax降低,IVC时长延长(均P<0.05);据VFM观测三腔起搏状态时主动脉开放瞬间PH更靠近左室后侧壁、PL更靠近基底部、Vmax增加,IVC-△PH增大,涡流观测终点VA、FA均较两腔起搏时小,以上参数(均P<0.05)。结论关闭左心室起搏器会对部分常规超声心动图参数及VFM参数产生不良影响,即三腔起搏状态较两腔起搏状态能够更好的辅助左心腔做功。VFM技术能够客观有效地反映关闭左心室起搏后左室收缩期血液流场的变化。Objective To evaluate left ventricular systolic function and blood flow field with closed Left ventricular pacemaker in mid-term cardiac resynchronization therapy patients by vector flow mapping(VFM).Methods 17 patients who were enrolled in this study after CRT pacemaker implantation from 6 months to 12 months.Echocardiographic examination were carried out in all patients before and after closed Left ventricular pacemaker.Left ventricular blood flow vector image acquisition by using VFM software,then observe their evolution characteristics and the correlation with conventional echocardiographic relevant parameters.Results Compared with three chamber pacemaker,MRV was increased,but LVDp/Dtmax was decreased,and IVC was prolonged in patients after closed the left ventricular pacemaker for 30minutes(P<0.05).According to the results of VFM analysis in 17 cases,in the three chamber pacing,at the point of AVO PH were close to posterior lateral wall of left ventricle,and PL were close to base wall of left ventricle,Vmax was increased,IVC-△PH were increased,at the point of END FV and VA were decreased(P<0.05).Conclusions There were significant negative effects on conventional echocardiographic parameters and VFM parameters when closed left ventricular pacemaker in mid-term cardiac resynchronization therapy patients;The changes of intra-cardiac flow fieldcould be easily and visually analyzed by VFM technique.

关 键 词：血流向量成像 心脏再同步化治疗 左心室 收缩期 

分 类 号：R540.45[医药卫生—心血管疾病] R541[医药卫生—内科学]