左心室四极导线对心脏同步性和急性血液动力学的影响

摘要

目的 评价左心室四极导线对心脏同步性和急性血液动力学的影响. 方法 选择符合心脏再同步治疗( CRT)适应证的患者共60 例,分为四极导线组和双极导线组,各30例,通过超声心动图测量两组心脏同步性指标如室间隔-左室后壁收缩延迟( SPWMD)、12个室壁节段收缩速度达峰值时间的标准差( Ts-SD)、16个室壁节段收缩达最小容积时间的差值( Tmsv16-Dif )、心率矫正后的16 个室壁节段收缩达最小容积时间的标准差[Tmsv16-SD(%R-R)]、峰值收缩径向应变最大达峰时间标准差( Trs-SD)和峰值收缩径向应变率最大达峰时间标准差( Trsr-SD) ,及急性血液动力学指标每搏输出量( SV)、主动脉流速时间积分( VTI)、二尖瓣返流面积( MR) ,比较手术前后两组间差异. 结果 术后两组心脏同步性指标均显著改善,四极导线组 Ts-SD、Trs-SD和Trsr-SD优于双极导线组(P<0. 05),三维超声Tmsv16-Dif和Tmsv16-SD(%R-R)亦优于双极导线组( P<0. 01 ). 两组术后血液动力学均显著改善,与双极导线组比较,四极导线组SV和VTI更佳( P<0. 05 ) ,但MR两组间差异无统计学意义. 结论 左心室四极导线可带来更佳的心脏同步性和急性血液动力学,优于双极导线.%Objective To explore the effect of quadripolar LV lead on cardiac synchronization and acute hemody-namic. Methods 60 patients in CRT indications were selected into this study and divided into quadripolar LV lead group and bipolar LV lead group according to the type of left ventricular lead. Both quadripolar LV gruop and bipo-lar LV gruop had 30 patients. Echocardiographic examinations were performed to assess the cardiac synchronization, including septal to posterior wall motion delay ( SPWMD) , standard deviation of 12 LV segments′Ts( Ts-SD) , the deviation of time to minimum systolic volume of the 16 LV segments ( Tmsv16-Dif ) , the time to minimum systolic volume of the 16-segmental standard deviation as a ratio of R-R interval [ Tmsv16-SD(%R-R) ] , the standard de-viation of the peak time of systolie radial strain( Trs-SD) and the standard deviation of the peak time of systolie ra-dial strain rate( Trsr-SD) ,and the acute hemodynamic, including stroke volume( SV) , aortic velocity-time integral (VTI) and mitral regurgitati(MR). Results Cardiac synchronization were significant improved after CRT-D in both group. Ts-SD, Trs-SD and Trsr-SD(P<0. 05), especial Tmsv16-Dif and Tmsv16-SD(%R-R)(P<0. 01) in quadrupolar LV lead group were superior to these in bipolar LV lead group. Meanwhile, quadrupolar LV lead group had a significantly higher level of SV(P<0. 05) and VTI(P<0. 05) than bipolar LV lead group,but the MR did not significantly reduced compared with bipolar LV lead gruop. Conclusion Compared with bipolar LV lead, quadripolar LV lead could make better contributions to heart synchronicity and acute hemodynamic.