Assessment of left ventricular function and synchronicity after pacemaker implantation in different locations using four-dimensional speckle tracking imaging and three-layer speckle tracking echocardiography

doi:10.3877/cma.j.issn.1672-6448.2021.02.003

Abstract

Abstract:

Objective

To evaluate left ventricular (LV) systolic function and synchronicity after pacemaker implantation in different locations of the right ventricle by four-dimensional speckle tracking imaging (4D-STI) and three-layer speckle tracking echocardiography.

Methods

One hundred patients who received permanent cardiac dual-cavity pacemaker implantation at Beijing Fuwai Hospital from December 2018 to October 2019 were enrolled and divided into a right ventricle apex pacing (RVAP) group, right ventricular septum pacing (RVSP) group, and His bundle pacing (HBP) group based on the implantation location. Three-layer speckle tracking echocardiography was conducted to analyze LV three-layer myocardium (endocardial, mid, and epicardial layers) changes in longitudinal strain (LS), and peak strain dispersion (PSD) was used to evaluate LV synchronicity. 4D-STI was taken to obtain GLS, global circumferential strain(GCS), global radial strain(GRS), and global area strain(GAS). Preoperative and postoperative changes of the above indicators were compared between and within the three groups.

Results

Six months after surgery, PSD in the RVAP group was significantly longer than that before surgery (t=-4.502,P=0.004). PSD in both the RVSP and HBP groups was shorter than that before surgery, and the change was more significant in the HBP group(t=-2.363, P=0.04); the difference in PSD among the three groups was statistically significant (F=12.261, P＜0.001).GLS-epi in the RVAP group differed significantly between before and after surgery (t=-2.501, P=0.046), and the difference among the three groups was statistically significant (F=6.786, P=0.034). Six months after surgery, GLS, GCS, GRS, and GAS in the RVAP group were all lower than those before surgery, and the differences in GCS, GRS, and GAS were statistically significant (P=0.049,0.014,0.037). GLS (P＜0.001), GAS (P=0.002), and GRS (P=0.001) in the HBP group were significantly better than those in the RVAP group. GLS (P=0.01) and GAS (P=0.043) in the HBP group were significantly better than those in the RVAP group.

Conclusion

4D-STI and three-layer speckle tracking echocardiography can be used for quantitative analysis of LV systolic function and synchronicity after pacemaker implantation in different locations.HBP is more advantageous than RVAP and RVSP in improving the mechanical synchronization of the left ventricle. LV systolic function decreases early after RVAP. HBP and RVSP have no adverse effects on LV systolic function.

Key words: Cardiac pacing, Echocardiography, Speckle tracking imaging, Ventricular function, left

Hui Li, Min Gu, Yiran Hu, Hongxia Qi, Jie Liu, Hao Wang. Assessment of left ventricular function and synchronicity after pacemaker implantation in different locations using four-dimensional speckle tracking imaging and three-layer speckle tracking echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(02): 135-142.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.02.003

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Figures/Tables 8

临床资料	RVAP组（n=35）	RVSP组（n=35）	HBP组（n=30）	统计值	P值
年龄（岁， $x ¯$ ±s）	67.3±8.5	63.7±12.5	64.3±13.6	t=0.211	0.812
男性[例（%）]	18（51.4）	20（57.1）	18（60.0）	χ²=0.505	0.777
体质量指数（kg/m²， $x ¯$ ±s）	21.86±2.09	22.32±2.31	21.56±2.90	t=2.090	0.148
手术适应证[例（%）]
病态窦房结综合征	8（22.8）	6（17.1）	8（26.7）	χ²=0.868	0.648
高度房室传导阻滞	27（77.2）	29（82.9）	22（73.3）	χ²=0.868	0.648
合并疾病[例（%）]
高血压	16（45.7）	15（42.9）	16（53.3）	χ²=0.740	0.691
糖尿病	8（22.9）	8（22.9）	8（26.7）	χ²=0.165	0.921
冠心病	5（14.3）	5（14.3）	4（13.3）	χ²=0.016	0.992
高脂血症	7（20.0）	8（22.9）	6（20.0）	χ²=0.111	0.946
吸烟[例（%）]	5（14.3）	6（17.1）	6（20.0）	χ²=0.371	0.831

临床资料	RVAP组（n=35）	RVSP组（n=35）	HBP组（n=30）	统计值	P值
年龄（岁， $x ¯$ ±s）	67.3±8.5	63.7±12.5	64.3±13.6	t=0.211	0.812
男性[例（%）]	18（51.4）	20（57.1）	18（60.0）	χ²=0.505	0.777
体质量指数（kg/m²， $x ¯$ ±s）	21.86±2.09	22.32±2.31	21.56±2.90	t=2.090	0.148
手术适应证[例（%）]
病态窦房结综合征	8（22.8）	6（17.1）	8（26.7）	χ²=0.868	0.648
高度房室传导阻滞	27（77.2）	29（82.9）	22（73.3）	χ²=0.868	0.648
合并疾病[例（%）]
高血压	16（45.7）	15（42.9）	16（53.3）	χ²=0.740	0.691
糖尿病	8（22.9）	8（22.9）	8（26.7）	χ²=0.165	0.921
冠心病	5（14.3）	5（14.3）	4（13.3）	χ²=0.016	0.992
高脂血症	7（20.0）	8（22.9）	6（20.0）	χ²=0.111	0.946
吸烟[例（%）]	5（14.3）	6（17.1）	6（20.0）	χ²=0.371	0.831

参数	RVAP组（n=35）	RVSP组（n=35）	HBP组（n=30）	F值	P值
PSD (ms)
术前	52.7±10.0	62.7±15.7	65.4±18.1	1.459	0.254
术后6个月	71.6±6.0	50.4±19.2^a	53.3±16.7^a	12.261	＜0.001
t值	-4.502	1.667	-2.363
P值	0.004	0.145	0.040
GLS-endo(%)
术前	23.5±4.4	20.5±5.5	19.6±3.3	1.840	0.182
术后6个月	17.2±3.4	18.9±3.5	16.6±8.0	2.441	0.094
t值	-2.414	-0.192	1.404
P值	0.052	0.397	0.191
GLS-mid(%)
术前	21.2±3.8	18.6±5.1	17.4±3.2	1.990	0.161
术后6个月	15.5±3.1	17.5±3.7	16.8±2.7	2.742	0.091
t值	-2.443	-0.753	-1.494
P值	0.050	0.490	0.166
GLS-epi(%)
术前	18.3±3.5	16.8±4.7	15.8±3.1	2.096	0.147
术后6个月	12.1±8.1	15.6±3.4^b	14.0±2.8^b	6.786	0.034
t值	-2.501	-0.931	1.259
P值	0.046	0.388	0.237

参数	RVAP组（n=35）	RVSP组（n=35）	HBP组（n=30）	F值	P值
LVEDV（ml）
术前	89.3±22.0	91.6±27.8	91.8±26.2	0.023	0.977
术后6个月	81.5±22.5	88.7±24.4	82.5±14.0	1.435	0.245
t值	0.996	0.162	1.786
P值	0.358	0.877	0.104
LVESV（ml）
术前	32.0±5.7	34.3±8.1	34.1±11.7	0.134	0.876
术后6个月	30.7±7.6	32.7±7.0	32.8±8.0	0.699	0.500
t值	0.605	1.766	0.455
P值	0.567	0.128	0.659
LVEF（%）
术前	63.0±4.5	61.9±3.9	63.5±7.2	0.186	0.832
术后6个月	62.0±4.3	62.6±4.1	60.0±7.2	1.649	0.199
t值	0.387	-0.447	1.813
P值	0.712	0.671	0.100
4D-GLS（%）
术前	16.3±2.2	13.7±4.9	15.0±3.7	2.820	0.081
术后6个月	13.3±2.5	12.6±3.5	15.8±3.2^ab	11.392	＜0.001
t值	2.410	0.779	-0.325
P值	0.052	0.466	0.678
4D-GCS（%）
术前	19.1±4.4	15.7±2.0	15.9±5.6	1.332	0.284
术后6个月	14.3±3.7	13.6±3.9	14.7±3.4	0.569	0.569
t值	2.437	0.851	2.271
P值	0.049	0.472	0.053
4D-GAS（%）
术前	31.7±4.3	27.1±4.5	25.5±8.6	1.931	0.169
术后6个月	22.0±6.0	24.9±4.4	26.4±4.3^ab	5.371	0.007
t值	2.680	0.495	-2.227
P值	0.037	0.638	0.052
4D-GRS（%）
术前	53.7±8.3	42.9±9.3	43.0±7.8	1.575	0.229
术后6个月	33.3±10.6	39.6±7.5	42.4±8.1^a	6.480	0.003
t值	3.422	0.145	1.123
P值	0.014	0.889	0.546

参数	观察者内ICC值（95%CI）	P值	观察者间ICC值（95%CI）	P值
PSD	0.91（0.81~0.95）	＜0.001	0.90（0.87~0.95）	＜0.001
LVEF	0.92（0.85~0.96）	＜0.001	0.87（0.81~0.92）	＜0.001
GLS	0.91（0.84~0.94）	＜0.001	0.87（0.79~0.92）	＜0.001
GCS	0.90（0.84~0.95）	＜0.001	0.88（0.82~0.93)	＜0.001
GAS	0.91（0.86~0.96）	＜0.001	0.89（0.83~0.95）	＜0.001
GRS	0.90（0.85~0.96）	＜0.001	0.88（0.82~0.95）	＜0.001

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