文章摘要
陈银花,许 迪,姚 静,庄 燕,雍永宏.右室不同部位起搏时左室收缩时序及同步性的超声研究[J].南京医科大学学报,2009,29(8):1118~1123
右室不同部位起搏时左室收缩时序及同步性的超声研究
Echocardiographic assessment of left ventricular systolic sequence and synchrony during pacing at variant right ventricular sites
投稿时间:2009-02-09  
DOI:10.7655
中文关键词: 超声心动描记术  心脏起搏,人工  心肌收缩  同步性  斑点追踪显像
英文关键词: echocardiography  cardiac pacing,artificial  myocardial contraction  synchrony  speckle tracking imaging
基金项目:国家自然科学基金资助项目(30772060)
作者单位
陈银花 南京医科大学第一附属医院心脏科超声心动图室,江苏 南京 210029 
许 迪  
姚 静  
庄 燕  
雍永宏  
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中文摘要:
      目的:探讨超声斑点追踪成像技术评价右室间隔部起搏与右室心尖部起搏对左心室心肌收缩时序及同步性影响的应用价值?方法:获取右室间隔起搏组(9例)?右室心尖起搏组(15例)?正常对照组(13例)心尖四腔观?二腔观?左心室长轴观,胸骨旁左室短轴二尖瓣水平?乳头肌水平和心尖水平的图像,测量左室各节段收缩期纵向应变达峰时间(TsL),胸骨旁短轴观测量收缩期径向应变达峰时间(TsR)和径向应变率达峰时间(TsrR),并计算节段达峰时间的标准差(TsL-SD,TsR-SD,TsrR-SD)及任意两节段间达峰时间最大差值(TsL-d,TsR-d,TsrR-d)作为左室收缩不同步性指标?通过分析收缩期纵向应变达峰时间,评估各组内左室机械收缩时序?结果:右室心尖起搏组纵向与径向收缩不同步性指数高于正常对照组及右室间隔起搏组,差异均具有统计学意义(P < 0.05),而右室间隔起搏组与正常对照组纵向与径向收缩不同步性指数差异均无统计学意义?右室间隔起搏组左室收缩时序与正常对照组类似,右心室心尖起搏组的左心室壁收缩时序较正常对照组发生改变,左室整体收缩达峰时间较正常对照组及右室间隔起搏组延迟,多数节段差异具有统计学意义(P < 0.05)?结论:右室心尖起搏较右室间隔部位起搏左室心肌在纵向?径向上均存在显著的收缩不同步,提示与异常的电机械激动顺序相关?斑点追踪成像技术可用于右室不同部位起搏对左室心肌收缩同步性及收缩时序影响的评价?
英文摘要:
      Objective:To assess left ventricular(LV)systolic sequence and synchrony by speckle tracking imaging during right ventricular septum pacing and right ventricular apex pacing. Methods:Myocardial imaging of LV apical views and parasternal LV short axis(SAX)views was performed in 9 patients with right ventricular septum pacing(DDDspt group),15 patients with right ventricular apex pacing(DDDapx group)and 13 healthy subjects(control group).The time to peak systolic longitudinal strain(TsL)in the LV apical views,the time to peak systolic radial strain(TsR)and systolic radial strain rate(TsrR)in the LV SAX views were measured. The standard deviation of TsL,TsR and TsrR(TsL-SD,TsR-SD and TsrR-SD)and the maximal temporal difference of TsL,TsR and TsrR(TsL-d,TsR-d and TsrR-d)of 18 segments were used as an indicator of LV systolic dysynchrony,to evaluate the contraction sequence of the LV wall by analyzing TsL. Results:Compared with control group and the DDDspt group,TsL-SD,TsR-SD,TsrR-SD and TsL-d,TsR-d,TsrR-d were significantly higher in DDDapx group (P < 0.05). No significant difference was found between DDDspt group and control group. Left ventricular contraction sequence was similar in DDDspt group and control group,but it changed during right ventricular apical pacing. The contraction of the whole LV delayed in DDDapx group compared with DDDspt group and control group,most segments showed significant differences(P < 0.05). Conclusion:DDDapx group showed significant LV longitudinal,radial systolic dyssynchrony compared with DDDspt group,by inducing different electromechanical activation sequence. Speckle tracking imaging is a useful modality to evaluate systolic sequence and synchrony of the LV during pacing at variant right ventricular sites.
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