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组织多普勒评价心力衰竭患者双心室优化起搏与同步起搏即刻室壁运动不同步性 被引量：5

Tissue Doppler imaging evaluates immediate improvement of left ventricular asynchronization by optimum sequential or simultaneous biventricular pacing in patients with congestive heart failure
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摘要 目的应用组织多普勒超声(TDI)同步化显像(TSI)、组织速度显像(TVI)比较双心室同步起搏与双心室优化起搏左心室室壁运动不同步性的即刻变化。方法对接受双心室优化起搏治疗的10例原发性扩张型心肌病患者,分别记录起搏器植入术前双心室同步起搏与优化起搏即刻状态下的左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、每搏量(SV)主动脉瓣口的速度时间积分(VTI)、计算TVI模式下左心室12个节段的QRS时间起始点距左心室各节段收缩峰值时间的标准差(Ts-SD),根据TSI的色彩计算TSI指数(TSI-Index)。同时记录起搏器植入术前后6min步行实验(6MHW)和心功能NYHA分级。结果双心室优化起搏即刻Ts-SD、TSI指数与主动脉瓣VTI优化起搏状态(45.21±18.35ms,1.71±0.29,25.44±5.36cm)均明显优于同步起搏(50.16±19.72ms,1.87±0.31,22.44±5.43cm)(P<0.05)。SV优化起搏即刻(48.0±14.7ml)比术前(36.0±14.9ml)增加(P<0.05)。结论双心室优化起搏治疗重度充血性心力衰竭,能改善左心室室壁运动的不同步性并提高左心室射血量。在改善左心室射血和组织运动不同步性,术后优化起搏即刻显著优于同步起搏。 Objective To evaluate immediate impact of optimum sequential or simultaneous biventricular pacing on left ventricular asynchronization with tissue synchronization imaging （＇PSI） and tissue velocity imaging （TVI）. Methods 10 patients with dilated cardiomyopathy received optimum sequential biventricular pacing. Left ventricular ejection fraction, stroke volume （SV）, aortic velocity time integral （VTI）, left ventrieular end diastolic diameter, standard deviation of time from QRS onset to peak systolic velocity of 12 left ventricular segments （Ts-SD） and TSI index was assessed before implantation, during simultaneous biventricular pacing or optimum sequential biventricular pacing, respectively. Ts-SD was measured by TVI and TSI index was derived from TSI color codes. Results Compared with simultaneous biventrieular pacing, optimum sequential biventricular pacing significantly decreased Ts-SD and ＇PSI index （from 50.16±19.72ms and 1.87±0.31 to 45.21±18.35ms and 1.71±0.29,ali P〈0.05） and increased VTI （from 22.44±5.43cm to 25.44±5.36cm, P〈 0.05）. Similarly, SV was significant greater during optimum sequential biventrieular paceing than that before implantation （48.0±14.7ml vs 36.0±14.9ml, P〈0.05 ）. Conclusion Optimum sequential biventrieular pacing is better than simultaneous biventricular pacing in improving immediate cardiac stroke volume and left ventricular asynchronization in patients with congestive heart failure.
作者 杨倩 王建安 董樑 周斌全 盛夏 孙勇 蒋晨阳
机构地区 浙江大学医学院附属邵逸夫医院超声科 浙江大学医学院附属第二医院心内科 浙江大学医学院附属邵逸夫医院心内科
出处 《心电学杂志》 2006年第2期69-73,共5页 Journal of Electrocardiology(China)
关键词 双心室顺序起搏 组织多普勒 心脏再同步化治疗 心力衰竭 Sequential biventricular pacing, Tissue Doppler imaging, Cardiac resynchronization therapy, Heart failure
分类号 R541.6 [医药卫生—心血管疾病]
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参考文献21

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二级参考文献18

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共引文献38

同被引文献72

  • 1史浩颖,潘翠珍,舒先红,汪芳,金炜,张建军,陈岗,孙宝贵.组织多普勒技术评价双心室同步起搏即刻疗效[J].中华心血管病杂志,2005,33(1):26-29. 被引量：23
  • 2周智慧,赵宝珍,姥义,薛海萍.ICK和TDI技术定量评价心力衰竭患者右室舒张功能的可行性[J].中国医学影像技术,2005,21(12):1908-1911. 被引量：8
  • 3王方正,张澍,黄德嘉,华伟,孙宝贵,沈法荣,吴书林,王建安,方全,吴立群,王景峰,王冬梅,郭涛,陈新,中华医学会心电生理和起搏分会心脏再同步治疗专家工作组.心脏再同步治疗慢性心力衰竭的建议[J].中华心律失常学杂志,2006,10(2):90-102. 被引量：91
  • 4柳志红,秦春常.欧洲心脏病学会肺动脉高压指南解读[J].中国实用内科杂志,2007,27(4):243-246. 被引量：24
  • 5Bax JJ,Ansalone G,Breithardt OA,et al.Echocardiographic evaluation of cardiac resynchronization therapy:ready for routine clinical use:a critical appraisal.J Am Coll Cardiol,2004,44(1):1-9.
  • 6Cleland JG,Daubert JG,Erdmann E,et al.The effect of cardiac resynchronization on morbidity and mortalily in heart failure.N Engl J Med,2005,352(15):1539-1549.
  • 7Ghio S,Constantin C,Klersy C,et al.Interventricular and intraventricular dyssynchrony are common in heart failure patients,regardless of QRS duration.Eur Heart J,2004,25(7):571-578.
  • 8Yu CM,Fung WH,Lin H,et al.Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy.Am J Cardiol,2002,91(6):684-688.
  • 9Sogaard P,Eglebad H,Pedersen AK,et al.Sequential versus simultaneous biventricular resynchronization for severe heart failure:evaluation by tissue Doppler imaging.Circulation,2002,106(16):2078-2084.
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引证文献5

二级引证文献12

心电学杂志
2006年 第2期

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