Evaluation of left ventricular activation sequence and intraventricular synchronization in patients with left bundle branch pacing by two-dimensional speckle tracking imaging

doi:10.3877/cma.j.issn.1672-6448.2023.04.005

Abstract

Abstract:

Objective

To map the left ventricular activation sequence indirectly and analyze the intraventricular synchronization in patients with left bundle branch pacing (LBBP) by two-dimensional speckle tracking imaging (2D-STI).

Methods

Twenty-two patients with LBBP and 16 patients with right ventricular outflow tract pacing (RVOTP) in Chengdu Third People's Hospital from July 2020 to December 2020 were enrolled, and 17 healthy adults were selected as a control group. Strain-time curves were generated by 2D-STI. Onset time of systole (OTS) of positive curves was the time from the R wave to the positive peak strain. For negative curves, the largest value (S) of absolute strain values (Sn) at the second frame and the second frame time (T) were used to calculate the strain rate (V=S/T), and OTS was calculated as T-Sn/V. The standard deviation of peak time (Tp-SD) was used as the intraventricular synchronization parameter.

Results

QRS duration was the shortest in the control group [(95.35±10.04) ms], followed by the LBBP group [(113.41±11.46) ms], and it was significantly prolonged in the RVOTP group [(144.94±13.03) ms]; the difference between any two groups was statistically significant (P＜0.05). When comparing OTS at all levels, only OTS in the apical segment of lateral wall in the RVOTP group was significantly different from that in the control group [(29.56±13.33) ms vs (19.53±15.02) ms, P＜0.05]. OTS of the earliest excited segment was the lowest in the control group [(10.76±9.67) ms], followed by the LBBP group [(14.45±7.30) ms] and RVOTP group [(17.19±19.43) ms]. The difference of OTS between the earliest and the latest excited segments in each group was less than 40 ms. Compared with the LBBP group and the control group, Tp-SD in the global and middle segment was statistically different in the RVOTP group (P＜0.05), but there was no significant difference in Tp-SD in the basal segment and apical segment (P＞0.05). There was no significant difference in Tp-SD between the LBBP group and the control group (P＜0.05).

Conclusion

2D-STI can noninvasively map the left ventricular activation sequence and assist to find the change of activation sequence. LBBP can maintain relatively normal left ventricular activation sequence and intraventricular synchronization in the early stage after operation, and the synchronization is significantly better than that by RVOTP.

Key words: Speckle tracking echocardiography, Strain analysis, Left bundle branch pacing, Ventricular activation sequence, Intraventricular synchronization

Xiuxiu Wang, Shuangshuang Yan, Xiaoqi Deng, Feng Xiong. Evaluation of left ventricular activation sequence and intraventricular synchronization in patients with left bundle branch pacing by two-dimensional speckle tracking imaging[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(04): 404-410.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.04.005

https://chaosheng.cma-cmc.com.cn/EN/Y2023/V20/I04/404

Figures/Tables 9

一般资料	正常组（n=17）	LBBP组（n=22）	RVOTP组（n=16）	统计值	P值
年龄（岁， $x ¯$ ±s）	59.65±9.53	66.32±12.78	68.19±12.13	F=2.514	0.091
性别［男性，例（%）］	10（58.8）	13（59.1）	10（62.5）	χ²=0.059	0.971
心率（次/分， $x ¯$ ±s）	73.82±8.22	70.32±9.02	69.47±8.20	H=4.720	0.094
起搏指征				χ²=1.000	0.604
Ⅱ度Ⅱ型AVB［例，（%）］	-	8（36.4）	6（37.5）
Ⅲ度AVB［例，（%）］	-	14（63.6）	10（62.5）
基础疾病
高血压［例，（%）］	-	12（54.5）	6（37.5）	χ²=2.663	0.264
糖尿病［例，（%）］	-	8（36.4）	5（31.3）	χ²=0.233	0.890
QRS时限（ms， $x ¯$ ±s）	95.35±10.04	113.41±11.46^a	144.94±13.03^ab	F=77.080	＜0.001

一般资料	正常组（n=17）	LBBP组（n=22）	RVOTP组（n=16）	统计值	P值
年龄（岁， $x ¯$ ±s）	59.65±9.53	66.32±12.78	68.19±12.13	F=2.514	0.091
性别［男性，例（%）］	10（58.8）	13（59.1）	10（62.5）	χ²=0.059	0.971
心率（次/分， $x ¯$ ±s）	73.82±8.22	70.32±9.02	69.47±8.20	H=4.720	0.094
起搏指征				χ²=1.000	0.604
Ⅱ度Ⅱ型AVB［例，（%）］	-	8（36.4）	6（37.5）
Ⅲ度AVB［例，（%）］	-	14（63.6）	10（62.5）
基础疾病
高血压［例，（%）］	-	12（54.5）	6（37.5）	χ²=2.663	0.264
糖尿病［例，（%）］	-	8（36.4）	5（31.3）	χ²=0.233	0.890
QRS时限（ms， $x ¯$ ±s）	95.35±10.04	113.41±11.46^a	144.94±13.03^ab	F=77.080	＜0.001

超声心动图参数	正常组（n=17）	LBBP组（n=22）	RVOTP组（n=16）	统计值	P值
IVSd（mm）	9.59±0.94	10.14±1.13	9.88±0.96	F=2.239	0.326
LVPWd（mm）	9.69±0.87	10.19±0.91	10.00±1.21	F=1.261	0.292
LVDd（mm）	43.06±2.38	45.45±3.22	45.06±4.28	F=2.668	0.079
LVSd（mm）	29.63±2.60	31.31±3.55	30.25±3.09	F=2.224	0.118
LAD（mm）	35.00±3.13	36.64±3.53	35.81±2.99	H=4.134	0.127
LVEF（%）	63.59±2.21	61.45±1.71	62.81±5.46	H=5.832	0.054

组别	例数	前壁	侧壁	后壁	下壁	后间壁	前间壁
正常组	17	33.60±31.48	29.65±27.50	45.94±30.81	29.24±34.05	24.94±27.47	50.35±29.65
LBBP组	22	34.09±28.75	45.73±32.32	49.48±36.33	35.68±28.54	25.27±26.10	33.50±25.29
RVOTP组	16	36.69±18.60	43.94±22.37	40.25±35.24	52.13±43.70	26.33±34.66	33.38±31.02
H值		1.043	2.970	0.835	4.005	0.669	3.644
P值		0.549	0.227	0.659	0.135	0.716	0.162

组别	例数	前壁	侧壁	后壁	下壁	后间壁	前间壁
正常组	17	19.18±23.24	29.06±34.89	20.41±21.08	19.18±21.19	13.71±15.50	19.24±14.45
LBBP组	22	21.41±22.35	25.76±21.94	24.59±15.01	26.45±25.09	16.64±13.21	19.09±14.58
RVOTP组	16	17.19±19.43	29.50±29.31	27.81±20.04	26.31±28.21	19.88±25.30	17.25±13.95
H值		0.428	0.249	3.276	0.607	1.995	0.847
P值		0.807	0.883	0.194	0.738	0.369	0.665

组别	例数	前壁	侧壁	下壁	室间隔	心尖帽
正常组	17	18.47±11.03	19.53±15.02	16.65±15.54	10.76±9.67	17.82±11.31
LBBP组	22	18.32±5.69	22.77±9.89	22.86±11.40	14.45±7.30	25.77±10.12
RVOTP组	16	27.00±30.27	29.56±13.33^a	21.63±22.02	21.00±22.73	22.06±13.04
统计值		H=0.942	H=7.943	H=4.052	H=3.157	F=2.337
P值		0.624	0.019	0.132	0.206	0.107

组别	例数	整体	基底段	中间段	心尖段
正常组	17	38.02±4.67	40.56±3.89	36.40±3.49	36.90±6.16
LBBP组	22	40.39±3.18	41.65±4.17	40.22±2.52	39.09±2.47
RVOTP组	16	46.80±7.08^ab	44.91±2.42	51.80±9.57^ab	43.08±4.33
统计值		H=21.097	F=2.403	H=13.053	H=5.360
P值		＜0.001	0.124	0.001	0.069

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