Two-dimensional speckle tracking imaging evaluates right ventricular systolic function and synchrony in the early stage of left bundle branch pacing
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摘要: 目的 运用二维斑点追踪(2D-STI)技术对左束支区域起搏(LBBP)术后早期右心室收缩功能及同步性进行评价。方法 选取2020年8月—2021年1月于成都市第三人民医院心内科成功实施LBBP及右室流出道起搏(RVOP)的患者各23例。所有患者均于术后2周内行超声心动图检查。应用2D-STI技术分析和获取2组患者右心室整体、侧壁及室间隔纵向应变(LS)及相应的纵向应变达峰时间标准差(SD-Ts)。比较2组患者手术前后的常规参数及2D-STI参数。结果 ① RVOP组术后QRS时限明显增宽，且术后QRS时限RVOP组较LBBP组明显增宽(P< 0.001)。其余各常规指标在两组间差异均无统计学意义(P>0.05)。②LBBP组术后，右心室SD-Ts、间隔SD-Ts、侧壁SD-Ts均减小，且术后LBBP组右心室SD-Ts、侧壁SD-Ts较RVOP组亦明显减小，差异均有统计学意义(P< 0.05)。手术前、后右心室各应变指标在两组间差异均无统计学意义(P>0.05)。结论 2D-STI技术可客观、精确地评价不同部位起搏术后右心室收缩功能及同步性。LBBP作为一种全新的生理性起搏方式，能有效地维持右心室收缩同步性。Abstract: Objective To evaluate early right ventricular systolic function and synchronicity of left bundle branch pacing using two-dimensional speckle tracking imaging(2D-STI).Methods Forty six patients who received permanent cardiac implantation were enrolled from August 2020 to January 2021 in The Third People's Hospital of Chengdu. Patients were divided into left bundle branch pacing(LBBP) group(n=23) and right ventricular outflow tract pacing(RVOP) group(n=23). Echocardiography was performed at two weeks after surgery. The global longitudinal strain(GLS) and standard deviation of the time to peak strain(SD-Ts) of RV, the longitudinal strain(LS) and SD-Ts of lateral wall and ventricular septum were analyzed and obtained using 2D-STI. General and 2D STI parameters were compared between the two groups before and after operation.Results (1) The QRS wave duration was significantly longer in RVOP group after operation and was also significantly longer than in LBBP group(P< 0.001). No significant differences were detected in the rest parameters(P>0.05). (2) The SD-Ts of RV, ventricular septum and lateral wall were decreased in LBBP group after operation(P< 0.05). Compared with RVOP group, the SD-Ts of RV and lateral wall were also decreased in LBBP group after operation(P< 0.05). There were no differences of the strain index between two groups before and after operation(P>0.05)Conclusion 2D-STI is an objective and accurate method to evaluate RV global systolic function and synchrony.
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表 1 两组一般临床资料比较
Table 1. General data
X±S 项目 LBBP组(23例) RVOP组(23例) 年龄/岁 66.60±11.86 70.60±9.43 心率/(次·min-1) 69.78±6.76 67.47±8.60 男性/例(%) 9(39.1) 13(56.5) 病因/例(%) 高度房室传导阻滞 9(39.1) 11(47.8) 三度房室传导阻滞 14(60.9) 12(52.2) 合并症/例(%) 高血压 15(65.2) 18(78.3) 糖尿病 12(52.2) 10(43.5) 术前QRS波时限/ms 120.39±23.99 121.30±23.19 术后QRS波时限/ms 113.04±11.13 146.04±12.421)2) RVOP组术后与术前比较，1)P < 0.001；LBBP组与RVOP组术后比较，2)P < 0.001。 
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表 2 两组常规超声心动图参数比较
Table 2. Conventional echocardiographic parameters
X±S 指标 LBBP组 RVOP组 术前 术后 术前 术后 RVD1/mm 53.47±5.89 51.39±7.24 52.38±5.98 54.17±6.65 RVD2/mm 35.68±4.67 37.52±3.99 34.89±5.23 36.69±3.88 RVD3/mm 31.53±3.94 29.95±5.80 30.25±3.38 29.08±4.08 FAC/% 50.05±4.28 51.25±6.08 48.23±5.59 48.15±6.20 S′/(cm·s-1) 12.38±2.61 11.98±1.85 13.02±1.69 11.47±1.13 TAPSE 19.20±3.78 18.71±2.52 21.06±4.23 19.39±3.05 LVEF/% 62.38±3.42 59.74±4.49 61.58±4.67 60.82±4.43 E/A 0.97±0.26 0.81±0.35 0.89±0.43 0.93±0.36
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表 3 两组手术前后右心室收缩功能比较
Table 3. Right ventricular systolic function
X±S 指标 LBBP组 RVOP组 术前 术后 术前 术后 GLS/% -20.71±5.41 -21.48±5.46 -20.65±4.62 -19.47±4.39 SLS/% -17.79±4.66 -18.89±5.40 -17.00±4.17 -15.97±4.32 LLS/% -23.20±6.43 -24.60±6.31 -24.15±5.68 -22.98±5.81
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表 4 两组手术前后右心室收缩同步性比较
Table 4. Right ventricular systolic synchrony
X±S, M(P25, P75) 指标 LBBP组 RVOP组 术前 术后 术前 术后 RV SD-Ts/ms 53.75±23.75 34.71±24.031)2) 48.83±25.84 56.69±27.88 S SD-Ts/ms 31.37(23.09, 43.46) 20.75(11.95, 36.30)1) 35.43(10.32, 59.39) 40.84(16.39, 74.48) L SD-Ts/ms 34.95(23.48, 73.57) 22.53(7.84, 59.87)1)2) 34.67(20.34, 58.98) 46.58(25.48, 68.39) 与本组术前比较，1)P < 0.05；与RVOP组术后比较，2)P < 0.05。
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