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目的应用斑点追踪成像技术(STI)评价不同起搏模式下左心室扭转及解旋功能。方法选取窦性心动过缓为主,具有正常的房室传导顺序的病态窦房结综合征(SSS)并植入DDDR心脏起搏器的患者45例,每例入选患者随机进行心房起搏心室起搏(APVP)、心房起搏心室感知(APVS)和心房感知心室感知(ASVS)模式起搏各90 min,通过超声心动图技术获取每例患者3种模式下胸骨旁左室心尖和基底段短轴的二维动态图像存储,导入EchoPAC工作站脱机分析。应用STI技术分析左室心肌的扭转及解旋功能。结果与ASVS和APVS起搏模式比较,APVP起搏模式下LVEF、SV、左心室心尖部峰值旋转角度(PAr)明显降低,E/E、左心室心底部任意两节段旋转角度达峰时间最大差值(PBR-diff)增大,左心室峰值旋转角度(Ptw)和收缩末期扭转角度(AVCtw)减少(P<0.05);与ASVS起搏模式比较,APVP起搏模式下等容舒张期末扭转角度(MOVtw)和解旋率(UntwR)低于ASVS起搏模式(P<0.05);与APVS和APVP起搏模式相比,ASVS起搏模式下心率降低,LVEDD增大,左心室心底部峰值旋转角度达峰时间(Time to PBr)延迟(P<0.05)。结论 3种起搏模式中,固有心房和心室起搏的APVP模式下扭转运动受损,解旋能力下降,基底段旋转不同步,心尖旋转能力下降。相反,更生理的ASVS起搏模式下能较好保存心肌协调的旋转及解旋功能。
Objective To evaluate left ventricular torsion and unravel function in different pacing modes by using speckle tracking imaging (STI). Methods Forty-eight patients with sinus tachycardia, normal sinus node syndrome (SSS) with atrioventricular conduction sequence and implanted DDDR cardiac pacemaker were enrolled in this study. Each patient enrolled was randomized to atrial pacing ventricular APVP, APVS and ASVS mode of pacing were performed for 90 min. Echocardiographic technique was used to obtain the sternal parasagittal and basal segments of each patient under 3 modes Short-axis 2D dynamic image storage, import EchoPAC workstation offline analysis. Analysis of Left Ventricular Myocardial Torsion and Spinning Using STI Technique. Results Compared with the pacing mode of ASVS and APVS, LVEF, SV and PAr in APVP pacing mode were significantly lower than those in APVS pacing mode. The peak rotation time of E / E and any two segments at the bottom of left ventricular myocardium was the largest (Ptw) and AVCtw (P <0.05). Compared with the pacing mode of ASVS, the end-to-end diastolic phase of APVP pacing mode was reversed The values of MOVtw and UntwR were lower than those of ASVS (P <0.05). Compared with the APVS and APVP pacing modes, the heart rate and the LVEDD were increased in the ASVS pacing mode, Time to PBr delay (P <0.05). Conclusions Among the three pacing modes, APVP mode with intrinsic atrial and ventricular pacing impaired torsional motion, decreased ability to unwind, delayed basal segment rotation, and reduced apical spinnability. In contrast, the more physiological ASVS pacing mode better preserves myocardial coordination of rotation and unpinning function.