组织运动瓣环位移技术评价右心室心尖部起搏对左心室收缩功能的早期改变

目的：采用组织运动瓣环位移技术（TMAD）检测长期右心室起搏（RVAP）对左心室整体与节段收缩功能的影响，为左心室早期心功能受损检测提供新的方法。方法入选行DDDR模式起搏的患者53例为研究对象，均为RVAP，在术前以及术后1年采用TMAD技术检测二尖瓣环六个位点二尖瓣环位移（MADseg）、整体位移（MADglobal），采用M型超声检测左心室收缩期同步性指标TAS-POST以及双平面法测量左心室射血分数（LVEF），实验室检查 N 末端 B 型利钠肽原（NT-proBNP），根据起搏器程控检查计算心室累计起搏比例（Cum%VP）。同期选择性别、年龄相匹配的健康人60例作为对照组。结果与术前以及健康对照组比较，术后DDDR组LVEF、NT-proBNP无显著改变（P＞0.05），然而其二尖瓣环各位点MAD以及二尖瓣环MADglobal均减低（P＜0.05）；与术前比较，DDDR组术后TAS-POST增加（P＜0.05）。相关性分析显示，MADglobal与Cum%VP显著负相关（r＝-0.646，P＝0.000）。结论长期RVAP左心室纵向整体与节段收缩功能以及同步性减低，TMAD可早期监测心功能受损，为长期RVAP患者早期心功能异常的检测提供新的方法。

Early changes of long-term right ventricular apical pacing on left ventricular myocardial systolic function by tissue motion annular displacement

Objective To evaluate the effects of long-term right ventricular apical pacing（RVAP） on left ventricular myocardial systolic function by tissue motion annular displacement, and to provide evidence for early diagnosis myocardial dysfunction. Methods 66 patients were performed an implantation of pacemaker, and TMAD was performed before and one year after the pacemaker implantation to assess LV systolic synchrony and segment motion annular displacement（MADseg）, global motion annular displacement（MADglobal）, and detect BNP levels, calculate pacing （Cum%VP） were analyzed as well. In addition, 60 controls matched by age and gender were studied. Results After long-term RVAP, he MADseg at the four site and MADglobal were significantly decreased compared with control group and before RVAP（P〈0.05）, TAS-POST were significantly increased（P〈0.05）. The MADglobal negatively related with Cum%VP（r=-0.646, P=0.000）. Conclusions The left ventricular longitudinal systolic function were damaged in patients with RVAP. The technique of tissue mitral annular displacement provide new method for early diagnosis myocardial dysfunction in patients with RVAP.