文章摘要
徐亮,许迪,姚静,雍永宏,洪牮,陆美娟,李相权.右室不同部位起搏对左室收缩同步性及心功能影响的超声研究[J].南京医科大学学报,2011,(3):384~387
右室不同部位起搏对左室收缩同步性及心功能影响的超声研究
Echocardiographic assessment of left ventricular systolic synchronicity and function during pacing at variant right ventricular sites
投稿时间:2010-07-30  
DOI:10.7655
中文关键词: 实时三维超声心动图  同步性  心功能  起搏部位
英文关键词: real-time three-dimensional echocardiography  synchrony  cardiac function  cardiac pacing site
基金项目:国家自然科学基金资助(30772060)
作者单位
徐亮 南京医科大学第一附属医院心内科,江苏 南京 210029 
许迪 南京医科大学第一附属医院心内科,江苏 南京 210029 
姚静 南京医科大学第一附属医院心内科,江苏 南京 210029 
雍永宏 南京医科大学第一附属医院心内科,江苏 南京 210029 
洪牮 南京医科大学第一附属医院心内科,江苏 南京 210029 
陆美娟 南京医科大学第一附属医院心内科,江苏 南京 210029 
李相权 南京医科大学第一附属医院心内科,江苏 南京 210029 
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中文摘要:
      目的:应用实时三维超声心动图及其定量技术,分析右室不同部位起搏即刻左室收缩同步性和收缩功能的变化?方法:建立犬右室心尖部(RVA)(n=6)和右室流出道(RVOT)(n=6)起搏模型,分别采集窦性心律(SR)?RVA及RVOT起搏3种状态下经胸超声心动图实时三维全容积图(RT-3DE)?应用左室定量容积分析软件,获取左室整体及16节段容积时间曲线,分别计算16节段?12节段(中间段和基底段)?6节段(基底段)最小收缩容积到QRS波起始点时间(Tmsv)的标准差(Tmsv-SD)和最大差值的绝对值(Tmsv-Dif)及其占心动周期的百分比(Tmsv-SD%,Tmsv-Dif%)?左室舒张末容积(EDV)?左室收缩末容积(ESV)?左室每搏输出量(SV),左室射血分数(LVEF)?结果:与SR组比较,RVOT起搏组各参数均无统计学差异(P > 0.05),RVA起搏组Tmsv-16SD%?Tmsv-12SD%?Tmsv-6SD%?Tmsv-16Dif%?Tmsv-12Dif%?Tmsv-6Dif%均有统计学差异(P < 0.01),LVEF明显降低(P < 0.05),EDV及SV减小?ESV增大,但差异无统计学意义 (P > 0.05)?RVA起搏组与RVOT起搏组比较Tmsv-16SD%?Tmsv-12SD%?Tmsv-6SD%?Tmsv-16Dif%?Tmsv-12Dif%?Tmsv-6Dif%均有统计学差异(P < 0.05),且LVEF降低明显(P < 0.05),EDV?SV降低,ESV增大,但差异无统计学意义(P>0.05)?结论:右室流出道起搏时左室收缩同步性优于右室心尖部起搏,且对左室收缩功能的影响小?实时三维超声心动图可用于评价左室心肌收缩同步性和心功能?
英文摘要:
      Objective: To assess left ventricular systolic synchronicity and function with right ventricular out tract(RVOT) pacing or right ventricular apex(RVA) pacing by real-time three-dimensional echocardiography(RT-3DE). Methods:In the acute tests of anesthetized closed-chest beagle canines,acustom designed bipolar screw-in lead was implanted using a steerable delivery catheter guided with X-ray. The bipolar leads were implanted in the right ventricular apex or the right ventricular out tract. The dogs received right ventricular pacing at the rate of(138±33) beats per minute. SIEMENS ACUSON SC2000 with 4Z1c probe was used to perform full volume RT-3DE,16-segmental volume curves were obtained by the on-line LVA software.The end-systolic volume(ESV),end-diastolic volume(EDV),Stroke volume(SV),left ventricular ejection fraction(LVEF),the standard deviation(SD)and maximal difference(Dif) of the time to point with minimal systolic volume(Tmsv)of 16 segments,12 segments(6 mid and 6 basal)and 6 segments(basal)were calculated.Tmsv-SD% and Tmsv-Dif% were used to eliminate the influence of different heart rate. Results:There was no significant difference between sinus rhythm(SR)group and RVOT group(P > 0.05).After RVA pacing,Tmsv-16SD%,Tmsv-12SD%,Tmsv-6SD%,Tmsv-16Dif%,Tmsv-12Dif% and Tmsv-6Dif% were significant worsen than those in SR group(P < 0.01),while LVEF was lower(P < 0.05). Compared with RVOT group,Tmsv-16SD%,Tmsv-12SD%,Tmsv-6SD%,Tmsv-16Dif%,Tmsv-12Dif% and Tmsv-6Dif% were increased,and LVEF was decreased significantly(P < 0.05)in RVA group. Conclusion:RT-3DE is a feasible and reproducible method to quantify left ventricular synchrony and function.RVOT pacing in dogs is associated with more favorable immediate myocardial contraction and mechanical synchrony compared with RVA pacing.
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