【作者】 张志远；

【导师】 邱春光；

【作者基本信息】 郑州大学 ， 内科学， 2012， 硕士

【摘要】 目的采用三维斑点追踪成像技术(three-dimensional speckle tracking imaging,3D-STI)观察心脏再同步治疗(cardiac resynchronization therapy, CRT)患者优化心室起搏间期(VV间期)前后,左室收缩同步性的变化。方法入选我院因慢性心力衰竭接受CRT治疗的患者21例,所有入选患者均符合CRT植入类适应症,分别于术前3天,术后1周及斑点追踪指导优化VV间期后,采用3D-STI软件测量左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)和左心室不同步性参数,即左心室16个节段的面积追踪达峰时间标准差(AT-SD)和达峰时间最大差值(AT-Dif)。并于术前3天及术后1周测定血N末端脑钠肽(NT-proBNP)的变化。比较CRT术前、术后一周及斑点追踪最佳优化VV间期后,左室收缩同步性及收缩功能的变化。结果(1)术后1周患者血BNP水平较术前明显下降(P<0.001)；(2)双心室起搏1周后LVEDV和LVESV较术前均有明显的减小(P<0.001),AT-SD、AT-Dif均较术前明显减小(P<0.001),LVEF值明显升高(P<0.001)；(3)三维斑点追踪指导最佳VV间期优化前后,LVEDV无明显变化(P>0.05), LVESV、AT-SD、AT-Dif减小差异有统计学意义(P<0.05),LVEF值增加差异有统计学意义(P<0.05)。结论CRT术后左室收缩同步性、收缩功能及心功能明显改善,三维斑点追踪指导最佳VV间期优化后左室收缩同步性及收缩功能进一步改善,CRT术后个体化程控VV间期可进一步提高CRT的疗效。更多还原

【Abstract】 ObjectiveTo evaluate left ventricular systolic and diastolic synchronicity before and after optimal biventricular pacing by three-dimensional speckle tracking.Methods21chronic heart failure (CHF) patients with cardiac resynchronization therapy (CRT) were enrolled. Toshiba Artida4D system with PST-25SX probe were used to perform3D-STI in heart failure patients three days before CRT and one week after CRT and immediately after optimal biventricular pacing. The left ventricular end systolic volume(LVESV), left ventricular end diastolic volume(LVEDV) and left ventricular ejection fraction(LVEF) were obtained. The left ventricular dyssynchrony datasets which include the standard deviation of time to peak area tracking in the16left ventricular segments (AT-SD) and the maximum difference of time to peak area tracking in the16left ventricular segments (AT-Dif) were also investigated. And N-terminal pro-B-type natriuretic peptide (NT-proBNP) were obtained in three days before CRT and one week after CRT.Analyze the changes of left ventricular systolic and diastolic synchronicity between three days before CRT and one week after CRT and immediately after optimal biventricular pacing.Results(1) There was significant difference of NT-proBNP in three days before CRT and after it (P＜O.001).(2) Compared with three days before CRT, the LVEDV and LVESV and AT-SD and AT-Dif were decreased significantly in one week after CRT(P<0.001),and the LVEF was increased significantly(P<0.001).(3) Immediately after optimal biventricular pacing, the LVESV and AT-SD and AT-Dif were decreased further (P<0.05), and the LVEF was increased further (P＜O.05), while there was no significant change of LVEDV (P>0.05).ConclusionThe function of left ventricular and the systolic and diastolic synchronicity improved greatly after CRT, and the function of left ventricular and the systolic and diastolic synchronicity further improved after optimal biventricular pacing.Optimized VV interval of the pacemaker parameters enhanced the efficacy of CRT.更多还原