2022 年第 11 期 第 17 卷

应用实时三维超声心动图评价左束支区域起搏患者左心功能及同步性的研究

Prospective evaluation of left heart function and synchronization of patients with left bundle branch pacing by real-time three-dimensional echocardiography

作者：梅迎晨1韩蕊1程丽婷2何怡华3吴永全4刘巍1

英文作者：Mei Yingchen1 Han Rui1 Cheng Liting2 He Yihua3 Wu Yongquan4 Liu Wei1

单位：1北京积水潭医院心内科，北京100035；2南开大学医学院，天津300071；3首都医科大学附属北京安贞医院心脏超声医学中心，北京100029；4首都医科大学附属北京安贞医院心血管内科起搏中心二十一病房，北京100029

英文单位：1Department of Cardiology Beijing Jishuitan Hospital Beijing 100035 China; 2School of Medicine Nankai University Tianjin 300071 China; 3Echocardiography Medical Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 4Ward 21 Pacing Center Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：左束支区域起搏；心动过缓；实时三维超声心动图；同步性

英文关键词：Leftbundlebranchpacing;Bradycardia;Real-timethree-dimensionalechocardiography;Synchronization

• 摘要：

• 目的 应用实时三维超声心动图（RT-3DE）评价左束支区域起搏（LBBP）患者左心功能及同步性。方法 连续入选2021年1—7月于首都医科大学附属北京安贞医院因心动过缓（病态窦房结综合征和高度房室传导阻滞）需进行双腔永久起搏器植入手术，术前左心室射血分数＞50%，且术后第1天程控心室起搏比例＞70%的患者60例。依据心室起搏电极位置分为LBBP组、右心室间隔部起搏（RVSP）组，各30例。比较2组临床及手术资料，比较2组术前及术后12周二维超声心动图、RT-3DE指标及同步性指标。结果 术前及术后12周，2组左心室舒张末期内径、左心室收缩末期内径、左心室射血分数、二尖瓣口前向血流频谱E峰和A峰（心房收缩期和舒张晚期）速度比值、二尖瓣环侧壁和室间隔处舒张早期最大速度平均值（e′）、E/e′比值、左心室舒张末期容积、左心室收缩末期容积、三维左心室射血分数、每搏输出量、心指数、左心室舒张末期质量比较，差异均无统计学意义（均P＞0.05）。同步性指标方面，术后12周，LBBP组左心室16节段、12节段、6节段经R-R间期校正的从QRS波起点到最小收缩容积时间的标准差均低于RVSP组［（2.49±0.31）比（5.85±0.86）、（2.29±0.30）比（4.95±0.81）、（1.95±0.25）比（3.66±0.73）］（P=0.001、0.001、0.003）。结论 RT-3DE可有效评估双腔永久起搏器植入手术患者左心功能及同步性，LBBP患者心脏机械同步性好于RVSP患者，LBBP是更贴近生理性起搏的手术方式。

• Objective To evaluate the left heart function and synchronization of patients with left bundle branch pacing (LBBP) by real-time three-dimensional echocardiography (RT-3DE). Methods Totally 60 patients with bradycardia (sick sinus syndrome and high-grade atrioventricular block) requiring implantation of dual chamber permanent pacemaker were enrolled from January to July 2021 in Beijing Anzhen Hospital, Capital Medical University. The patients had preoperative left ventricular ejection fraction > 50% and programmed ventricular pacing rate > 70% on the first day after operation. Patients were divided into LBBP group and right ventricular septal pacing (RVSP) group according to the position of ventricular pacing electrode, with 30 cases in each group. The clinical and surgical data of the two groups were compared. Indexes of two-dimensional echocardiography, RT-3DE and synchronization were compared between the two groups before operation and 12 weeks after operation. Results Before operation and 12 weeks after operation, there were no significant differences in left ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular ejection fraction, velocity ratio of peak E to peak A (atrial systole and late diastole) in the anterior flow spectrum of the mitral valve orifice, the mean value of the maximum early diastolic velocity at the lateral wall of the mitral annulus and the ventricular septum(e′), E/e′ ratio, left ventricular end diastolic volume, left ventricular end systolic volume, three-dimensional left ventricular ejection fraction, stroke volume, cardiac index and left ventricular end diastolic mass between groups(all P＞0.05). In terms of synchronization indexes, at 12 weeks after operation, the standard deviation of the time from the QRS wave start to the minimum systolic volume corrected by R-R interval of 16, 12 and 6 segments of left ventricle in LBBP group was lower than that in RVSP group［(2.49±0.31) vs (5.85±0.86), (2.29±0.30) vs (4.95±0.81), (1.95±0.25) vs (3.66±0.73)］(P=0.001, 0.001, 0.003). Conclusion RT-3DE is a useful modality to evaluate left heart function and synchronization in patients implanted dual chamber permanent pacemaker. The cardiac mechanical synchronization in LBBP patients is better than that in RVSP patients, and LBBP is closer to physiological pacing.