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组织多普勒成像评价右室心尖部起搏与右室流出道起搏对心功能的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2007年第2期
页码:
226-229
栏目:
临床研究
出版日期:
2007-04-01

文章信息/Info

Title:
Effect of right ventricular outflow tract pacing and right ventricular apex pacing on cardiac function by tissue Doppler imaging
作者:
王蔚; 孟素荣; 陈哲明; 阮发晖; 杨溶海
南方医院心内科，广东 广州 510515
Author(s):
WANG Wei;  MENG Surong; CHEN Zheming; RUAN Fahui; YANG Ronghai
Department of Cardiology, Nanfang Hospital, Guangzhou 510515, Guangdong,China
关键词:
组织多普勒; 起搏部位; 心室同步; 心功能
Keywords:
tissue doppler imaging; cardiac pacing site;  ventricular synchronism;  cardiac function
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 研究比较右室心尖部起搏（RVAP）与右室流出道起搏（RVOTP）两种不同起搏方式对室壁运动的同步性、心功能的影响。方法 病窦综合征，Ⅲ度房室传导阻滞患者实施右室心尖部起搏15（男9，女6）例；实施右室流出道起搏10（男6，女4）例。所选患者均植入双腔起搏器，时间为术后3个月。利用组织多普勒速度时间曲线分别测量室间隔及左室各壁的基底段、中间段、心尖段的收缩达峰时间，在常规二维超声切面上测量心排出量（CO）、心脏指数（CI）、每搏量（SV）、心搏出量指数（SVI）、左室射血分数（LVEF）。结果 右室流出道起搏比右室心尖部起搏时CO［（4.7±1.1） vs （5.6±1.0）L/min,P<0.05］、CI［（3.1±0.7) vs (3.7±0.5)L/(min·m2),P<0.05］、SV［（70±14) vs (82±11)ml/次, P<0.05］、SVI［（42±9） vs （49±9）ml/(次·m2), P<0.05］、LVEF［（46±7） vs （57±15）%, P<0.05］均显著增加，收缩达峰时间显著缩短且一致性好（P<0.05）。结论 右室流出道起搏与右室心尖部起搏相比，接近正常的房室和心室激动顺序，使心室的收缩和舒张过程更协调，心室同步化更好，心功能得到更好的改善。组织多普勒技术能定量和半定量心室的同步性，具有广阔的临床应用前景。
Abstract:
AIM To compare the effect of right ventricular outflow tract (RVOT) pacing and that of right ventricular apex (RVA) pacing on the ventricular wall motion and cardiac function. METHODS RVA pacing was conducted in 15 patients (9 males and 6 females), of whom 10 had sick sinus syndrome (SSS) and 5 had Ⅲ° atrioventricular block, and , underwent RVA pacing was conducted in 10 patients (6 males and 4 females), of whom 5 had SSS and 5 had Ⅲ° atrioventricular block. Three months after installment of the dualchamber pacemakers, tissue Doppler imaging was used to evaluated the time to peak in systolic phase of interventricular septum and left ventricular. CO, CI, SV, SVI and LVEF were also measured by conventional 2Dimensional echocardiography. RESULTS Compared with RVA pacing, RVOT pacing better improved CO［（4.7±1.1） vs （5.6±1.0）L/min,P<0.05］、CI［（3.1±0.7) vs (3.7±0.5)L/(min·m2),P<0.05］、SV［（70±14) vs (82±11)ml/次, P<0.05］、SVI［（42±9） vs （49±9）ml/(次·m2), P<0.05］ and LVEF［（46±7） vs （57±15）%, P<0.05］. RVOT pacing significantly shortened the time to peak in systolic phase and improved the consistency of wall motion as compared with the RVA pacing. CONCLUSION Compared with RVA pacing, RVOT pacing with a more physiological depolarization pattern and theoretically better hemodynamics, significantly improves ventricular performance, including cardiac function and cardiac synchronism. Tissue Doppler imaging is useful in evaluating the synchronism of ventricular wall motion and cardiac function.

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备注/Memo

备注/Memo:
收稿日期：2006-02-09.通讯作者: 孟素荣,教授,主要从事心脏起搏与心电生理研究 作者简介: 王蔚,硕士Email: wei0729@fimmu.com
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