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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (12) : 1223 -1230. doi: 10.3877/cma.j.issn.1672-6448.2023.12.001

心血管超声影像学

斑点追踪成像和组织多普勒同步成像对不同起搏模式下左心室心肌同步性的评估
孟庆国1, 唐艺加2, 王斯佳1, 周杰2, 冯天航3, 刘学兵1, 舒庆兰1, 邓燕1, 尹立雪1,†(), 李春梅1   
  1. 1. 610072　成都，超声心脏电生理学与生物力学四川省重点实验室　四川省心血管病临床医学研究中心　国家心血管疾病临床医学研究中心分中心　四川省医学科学院·四川省人民医院心血管超声及心功能科
    2. 610072　成都，超声心脏电生理学与生物力学四川省重点实验室　四川省心血管病临床医学研究中心　国家心血管疾病临床医学研究中心分中心　四川省医学科学院·四川省人民医院心内科
    3. 610072　成都，超声心脏电生理学与生物力学四川省重点实验室　四川省心血管病临床医学研究中心　国家心血管疾病临床医学研究中心分中心　四川省医学科学院·四川省人民医院麻醉科
  • 收稿日期:2022-10-17 出版日期:2023-12-01
  • 通信作者: 尹立雪
  • 基金资助:
    四川省自然基金(2022NSFSC0662)

Evaluation of left ventricular myocardial synchrony under different pacing modes by speckle tracking imaging and tissue Doppler synchronous imaging

Qingguo Meng1, Yijia Tang2, Sijia Wang1, Jie Zhou2, Tianhang Feng3, Xuebing Liu1, Qinglan Shu1, Yan Deng1, Lixue Yin1,†(), Chunmei Li1   

  1. 1. Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, National Center for Clinical Medical Research of Cardiovascular Diseases, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China
    2. Department of Cardiology, Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, National Center for Clinical Medical Research of Cardiovascular Diseases, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China
    3. Department of Anesthesiology, Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, National Center for Clinical Medical Research of Cardiovascular Diseases, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China
  • Received:2022-10-17 Published:2023-12-01
  • Corresponding author: Lixue Yin
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引用本文：

孟庆国, 唐艺加, 王斯佳, 周杰, 冯天航, 刘学兵, 舒庆兰, 邓燕, 尹立雪, 李春梅. 斑点追踪成像和组织多普勒同步成像对不同起搏模式下左心室心肌同步性的评估[J]. 中华医学超声杂志（电子版）, 2023, 20(12): 1223-1230.

Qingguo Meng, Yijia Tang, Sijia Wang, Jie Zhou, Tianhang Feng, Xuebing Liu, Qinglan Shu, Yan Deng, Lixue Yin, Chunmei Li. Evaluation of left ventricular myocardial synchrony under different pacing modes by speckle tracking imaging and tissue Doppler synchronous imaging[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(12): 1223-1230.

目的

应用二维斑点追踪成像和组织多普勒同步成像（TSI）技术探讨右心双腔室间隔起搏（RVSP)与希浦系统起搏（HPSP）模式下患者左心室心肌同步性。

方法

前瞻性选取2020年2月至2021年9月于四川省人民医院接受房室全能型心脏起搏器植入的患者43例，按照起搏器植入方式不同将其分为RVSP组20例，HPSP组23例。同期选取40例志愿者为对照组。获取左心室节段应变达峰时间、应变达峰时间离散度（PSD）及左心室心肌做功等参数值。对二维斑点追踪评估的左心室17节段应变达峰时间、组织多普勒TSI评估的左心室12节段应变达峰时间及心肌做功参数和四维应变参数进行组间比较分析。

结果

组织多普勒TSI模式：与对照组比较，HPSP组、RVSP组12（12/12）个节段应变达峰时间均增大（P均<0.05）。HPSP组与RVSP组比较，4（4/12）个节段差异存在统计学意义，基底前壁、中段前间隔、中段间隔和中段后壁应变达峰时间RVSP组大于HPSP组（P均<0.05）。二维斑点追踪模式：与对照组相比，HPSP组和（或）RVSP组13（13/17）个节段应变达峰时间均增大（P均<0.05）。HPSP组与RVSP组相比，11（11/17）个节段差异存在统计学意义，其中7个节段HPSP组的应变达峰时间大于RVSP组（P均<0.05）。同对照组相比，左心室心肌长轴应变、左心室整体心肌做功效率在RVSP组明显减低（P均<0.05），而HPSP组与正常对照组比较差异无统计学意义（P均>0.05）。PSD在对照组、HPSP组和RVSP组逐渐递增（P<0.05）。

结论

在起搏器植入后6个月至1年的短期随访过程中，HPSP可以使左心室心肌更加协调、高效做功，左心室同步性优于RVSP。与组织多普勒技术相比，二维斑点追踪技术能够同时评估左心室心尖各节段心肌同步参数且不受角度依赖，相对更具优势。

关键词: 超声心动图, 斑点追踪成像, 组织多普勒同步成像, 希浦系统起搏, 右心室间隔起搏, 心肌功能
Objective

To investigate the advantages and disadvantages of left ventricular synchrony in patients with right ventricular double-chamber septal pacing (RVSP) and His-Purkinje system pacing (HPSP) using two-dimensional speckle tracking imaging and tissue synchrony imaging (TSI) techniques.

Methods

Forty-three patients who underwent atrioventricular universal pacemaker implantation at Sichuan Provincial People's Hospital from February 2020 to September 2021 were prospectively divided into an RVSP group (n=20) and an HPSP group (n=23). In the same period, 40 volunteers were selected as a control group. The dynamic two-dimensional grayscale and TSI images of the standard apical tri-plane section of each group were collected for three consecutive cardiac cycles, and the time to peak strain, peak strain dispersion (PSD), and the work of each segment of the left ventricle in the same cardiac cycle were obtained offline. The above parameters were analyzed and compared by taking the average of three cardiac cycles.

Results

With regard to TSI pattern, compared with the control group, the time to peak strain of 12 (12 /12) segments in both the HPSP group and RVSP group were increased (P<0.05 for all). There was a significant difference in the time to peak strain of 4 (4/12) segments between the HPSP group and RVSP group: The time to peak strain of the anterior basal wall, anterior septum of middle segment, middle septum, and posterior wall of middle segment in the RVSP group was longer than that in the HPSP group (P<0.05 for all). Two-dimensional speckle tracking imaging showed that compared with the control group, the time to peak strain of 13 segments in the HPSP group and/or RVSP group was increased (P<0.05). There was a significant difference in the time to peak strain of 11 (11/17) segments between the HPSP group and RVSP group, and the time to peak strain of 7 segments in the HPSP group was longer than that in the RVSP group (P<0.05 for all). Compared with the control group, the long-axis strain of the left ventricle and the overall myocardial work efficiency of the left ventricle decreased significantly in the RVSP group (P<0.05 for both), but there was no significant difference between the HPSP group and the normal control group (P>0.05 for both). PSD increased gradually and sequentially in the control group, HPSP group, and RVSP group (P<0.05).

Conclusion

During the short-term follow-up from 6 months to 1 year after pacemaker implantation, HPSP can make the left ventricular myocardium more coordinated and efficient, and the left ventricular synchronization is better than that with RVSP. Compared with TSI, two-dimensional speckle tracking technique can also simultaneously evaluate myocardial synchronization parameters of each segment of the left ventricular apex without angle dependence, which provides more comprehensive information for clinicians, suggesting that this technique has more advantages in evaluating synchronization.

Key words: Echocardiography, Speckle tracking imaging, Tissue synchrony imaging, His-Purkinje system pacing, Right ventricular septal pacing, Myocardial function
图1 左心室17节段应变达峰时间牛眼图。图a为健康者；图b为希浦系统起搏患者；图c为右心双腔室间隔起搏患者；图a~c左心室整体长轴应变呈依次递减趋势，应变达峰时间离散度（PSD）呈依次递增趋势
图2 左心室17节段心肌做功参数图像。图a为健康者；图b为希浦系统起搏者；图c为右心双腔室间隔起搏者（左心室做功效率希浦系统起搏者与健康者接近，右心双腔室间隔起搏者则呈现减低趋势）
图3 左心室基底和中段12节段应变达峰时间牛眼图。图a为健康者；图b为希浦系统起搏者；图c为右心双腔室间隔起搏者；图a~c的左心室节段心肌达峰时间（同步性）逐渐变差
表1 正常组与起搏组的一般资料比较（）
组别 例数 年龄 BSA（kg/m2） SPI（%） LVEF（%） EDV（ml） ESV（ml） HR（次/分） SBP（mmHg） DBP（mmHg）
RVSP组 20 69±12a 1.63±0.16 0.41±0.10 58.20±5.87 81.90±12.89 34.90±11.41 74±11 137±13 75±13a
HPSP组 23 72±4a 1.73±0.09 0.42±0.09 57.95±4.35 89.26±12.80 36.26±11.24 68±8 133±19 76±9a
正常对照组 40 64±11 1.62±0.15 0.37±0.06 61.76±7.16 88.76±19.21 31.88±12.05 67±6 118±10 64±6
F值 2.742 5.845 2.648 39.183 0.596 1.352 4.544 3.632 6.899
P值 0.025 0.167 0.064 0.988 0.624 0.232 0.452 0.242 <0.001
表2 正常组与起搏组17节段二维斑点追踪应变达峰时间比较（，ms）
节段 HPSP组（n=23） RVSP组（n=20） 正常对照组（n=40） F值 P值
基底间隔 335.35±104.24 344.73±68.88 330.20±31.61 0.25 0.77
基底前间隔 438.86±86.93ab 372.50±83.44a 330.80±21.00 14.85 <0.01
基底前壁 423.26±58.98ab 390.10±58.47a 334.40±16.48 21.29 <0.01
基底侧壁 372.90±68.48a 383.56±69.01a 329.80±59.20 4.08 0.02
基底后壁 377.13±56.36 376.60±58.70 348.60±24.93 2.73 0.07
基底下壁 389.35±52.52ab 324.91±43.97 339.04±76.18 4.62 0.01
中段间隔 334.95±49.62b 368.78±88.48a 321.40±19.17 7.25 <0.01
中段前间隔 431.43±88.67ab 379.86±97.34a 322.20±20.32 12.82 <0.01
中段前壁 415.21±76.45ab 386.15±73.55a 325.80±15.51 13.24 <0.01
中段侧壁 369.21±36.92ab 330.75±66.22 343.40±30.14 4.06 0.02
中段后壁 358.08±50.01 362.35±62.36 346.60±20.70 0.72 0.49
中段下壁 340.85±95.59 354.82±62.89 336.40±15.52 0.52 0.59
心尖段间隔 314.00±71.45b 391.95±80.63a 327.20±24.23 9.95 <0.01
心尖前壁 419.91±79.59ab 370.00±84.10a 328.60±20.52 11.42 <0.01
心尖侧壁 346.30±87.75a 361.30±36.79a 308.20±38.51 5.30 <0.01
心尖下壁 385.95±69.13ab 418.73±90.72a 323.00±17.04 13.27 <0.01
心尖帽 358.60±62.61ab 399.82±65.01a 335.00±23.40 9.83 <0.01
表3 正常组与起搏组左心室基底和中段水平12节段组织多普勒TSI应变达峰时间比较（，ms）
节段 HPSP组（n=23） RVSP组（n=20） 对照组（n=40） F值 P值
基底间隔 145.08±35.29a 145.40±39.86a 83.08±12.16 34.38 <0.01
基底前间隔 121.21±38.76a 131.25±62.85a 97.32±17.46 3.93 0.02
基底前壁 97.50±40.94ab 136.86±61.07a 74.56±16.98 12.69 <0.01
基底侧壁 160.69±69.45a 148.30±69.00a 87.72±13.51 11.81 <0.01
基底后壁 166.04±51.77a 171.45±67.37a 90.12±13.85 21.16 <0.01
基底下壁 148.26±56.88a 152.10±52.72a 92.52±7.10 13.62 <0.01
中段前间隔 105.55±16.46ab 134.13±50.06a 95.56±6.67 11.23 <0.01
中段间隔 136.00±47.40ab 153.70±48.33a 82.64±41.04 19.57 <0.01
中段前壁 125.86±49.87a 110.35±47.65a 84.24±6.96 6.99 0.02
中段侧壁 157.52±49.99a 146.20±64.78a 107.16±11.15 7.91 <0.01
中段后壁 140.91±56.72ab 156.25±70.48a 91.44±11.99 10.24 <0.01
中段下壁 156.95±53.38a 148.70±44.19a 66.72±15.32 36.56 <0.01
表4 正常组与起搏组心肌做功参数及四维应变参数比较（）
组别 例数 4D-GLS（%） GWI（mmHg%） GWE（%） GWW（mmHg%） PSD（msec）
HPSP组 23 -15.21±3.63b 1959.30±601.37ab 92.56±4.94b 62.88±34.90ab 67.69±20.88ab
RVSP组 20 -10.95±2.30a 1552.55±329.29a 83.90±4.03a 200.73±133.53a 78.05±20.91a
正常对照组 40 -16.60±4.26 1982.96±239.50 96.40±1.73 303.14±93.87 34.80±6.99
F值 13.787 7.900 32.800 32.726 31.978
P值 0.001 0.002 <0.001 <0.001 <0.001
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