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目的观察行单腔心脏起搏器植入术患者左心室心肌纵向应变(longitudinal strain,LS)、圆周应变(circumferential strain,CS)和径向应变(radial strain,RS)变化,探讨二维斑点追踪技术(two-dimensional speckle tracking imaging,2D-STI)在评估单腔心脏起搏器植入术后患者左心室功能中的价值。方法行单腔心脏起搏器植入术患者19例,其中心房颤动并Ⅲ度房室传导阻滞(atrioventricular block,AVB)患者12例(AVB组),病窦综合征(sick sinus syndrome,SSS)患者7例(SSS组),均植入VVI型起搏器。分别于VVI植入术前及术后1、3、6个月行超声检查,测量左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)和左室射血分数(left ventricular ejection fraction,LVEF),并应用2D-STI技术测量左心室心肌16节段LS、CS、RS。结果 SSS组VVI植入术后1、3、6个月LVEDV、LVESV、LVEF、LS、CS、RS与术前比较差异均无统计学意义(P>0.05);AVB组VVI植入术后1个月各指标与术前比较差异无统计学意义(P>0.05),术后3个月LVEF[(52.63±4.68)%]、CS[(-10.21±1.94)%]较术前[LVEF(46.09±5.92)%、CS(-9.40±1.88)%]增高(P<0.05),余指标与术前比较差异均无统计学意义(P>0.05);术后6个月,AVB组LVEF[(52.45±4.78)%]、RS[(11.94±2.03)%]较术前[LVEF(46.09±5.92)%、RS(9.02±2.38)%]增加,LVEDV[(182.68±32.62)mL]、LVESV[(132.78±27.38)mL]较术前[LVEDV(225.32±32.60)mL、LVESV(182.43±28.30)mL]下降,LS[(-11.92±1.69)%]、CS[(-11.23±1.87)%]较术前[LS(-8.52±1.82)%、CS(-9.40±1.88)%]绝对值增高,差异均有统计学意义(P<0.05)。结论 VVI植入术后6个月,心房颤动并Ⅲ度AVB患者左心室功能明显改善,SSS患者改善不明显;2D-STI可用于评估心房颤动并Ⅲ度AVB患者VVI植入术后左心室功能。
Objective To observe the changes of left ventricular myocardial longitudinal strain (LS), circumferential strain (CS) and radial strain (RS) in patients with single-chamber pacemaker implantation, (2-dimensional speckle tracking imaging, 2D-STI) in the evaluation of left ventricular function in patients with single-chamber pacemaker implantation. Methods Nineteen patients underwent single-chamber pacemaker implantation. Among them, 12 patients (AVB group) with atrial fibrillation and Ⅲ degree atrioventricular block (AVB), 23 patients with sick sinus syndrome SSS) patients in 7 cases (SSS group), were implanted VVI pacemaker. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (left ventricular end-systolic volume) were measured before VVI implantation and at 1, (LVESV) and left ventricular ejection fraction (LVEF). The 16 segments of left ventricular myocardium were measured by 2D-STI. Results There were no significant differences in LVEDV, LVESV, LVEF, LS, CS, RS between the 1 and 6 months after VVI implantation in the SSS group (P> 0.05) (P> 0.05). There was no significant difference between each index and the preoperative month (P> 0.05). The LVEF [52.63 ± 4.68]% and CS [10.21 ± 1.94% 46.09 ± 5.92)%, CS (-9.40 ± 1.88)%] (P <0.05). There was no significant difference between the remaining indexes and the preoperative values (P> 0.05) (52.45 ± 4.78)%], RS [(11.94 ± 2.03)%], LVEDV [(182.68 ± 32.62) mL], LVESV LS [(- 11.92 ± 1.69)%], CS [(- 11.23 ± 1.87)%] were significantly lower than those of preoperative [LVEDV (225.32 ± 32.60) mL vs LVESV (182.43 ± 28.30) mL] (P <0.05) compared with the preoperative [LS (-8.52 ± 1.82)%, CS (-9.40 ± 1.88)%] absolute value. Conclusions Six months after VVI implantation, left ventricular function was significantly improved in patients with atrial fibrillation and third degree AVB, while SSS patients showed no significant improvement. 2D-STI can be used to assess left ventricular function after AVVI in patients with atrial fibrillation .