双腔起搏器术后患者室壁运动同步性分析

目的分析永久性起搏器植入术后右心室起搏患者的心室间及心室内非同步收缩的特点及影响因素。方法收集永久性起搏器植入术后的患者22例,分为右心室起搏组与对照组。应用定量组织多普勒技术获得患者左心室各节段心肌及右心室侧壁的组织多普勒速度曲线,分别测量各节段自QRS波起始至心肌收缩期峰值速度和舒张早期峰值速度的时限等收缩期同步性指标和舒张期同步性指标,以及运动速度峰值。结果右心室起搏组与对照组两组间可测得的组织多普勒参数左心室壁12个节段收缩期达峰时间[(188.3±46.0)ms比(142.6±33.3)ms]差异有统计学意义(P<0.05),表明在心室起搏组存在左心室壁收缩的延迟。但有关左心室壁12个节段内运动同步性的参数,左心室壁12个节段收缩期达峰时间的标准差[(29.9±18.7)ms比(30.3±20.3)ms]及左心室壁12个节段收缩期达峰时间最大与最小值的差值[(95.6±60.4)ms比(90.0±58.3)ms]两组间差异无统计学意义。结论常规右心室心尖起搏致QRS波增宽,可造成心室间收缩不同步,但不一定会造成左心室内收缩不同步。     

右心室心尖部与间隔部起搏对室壁同步性的影响

目的:采用定量组织速度成像(QTVI)技术,评价右心室心尖部(RVA)及间隔部(RVS)起搏对室壁运动的影响。方法:选择56例RVA起搏(RVA)组患者,静息状态下同步记录磁频心电图,在QTVI模式下采集标准心尖四腔、心尖二腔和左室长轴的彩色组织多普勒图像并储存,测量左、右心室各室壁基底段、中间段心肌收缩时间间期,评价RVA与RVS起搏时心肌运动的变化。结果:①与RVS组比较,RVA组部分心肌收缩达峰时间明显延迟,以左室侧壁、后壁为著;②与RVS组比较,RVA组QRS波增宽,左心室内机械收缩同步性及左、右心室间机械收缩同步性降低。结论:与RVA起搏比较,RVS起搏有利于保持心肌电活动和机械收缩的同步性。     

右室心尖部与间隔部起搏对室壁运动的影响

目的采用定量组织速度成像(QTVI)技术,评价右室心尖部(RVA)及间隔部(RVS)起搏对室壁运动的影响。方法选择20例RVA起搏(RVA组)及20例RVS起搏(RVS组)患者,静息状态下同步记录磁频心电图,在QTVI模式下采集标准心尖四腔观、心尖二腔和左室长轴的彩色组织多普勒图像并储存,测量左、右心室各室壁基底段、中段心肌收缩时间间期,评价RVA与RVS起搏时心肌运动的变化。结果①与RVS组比较,RVA组部分心肌节段收缩达峰时间明显延迟,以左室侧壁、后壁为著。②与RVS组比较,RVA组QRS波增宽,左室内机械收缩同步性及左、右心室间机械收缩同步性降低。③RVA组收缩后再收缩以及舒张后期的异常收缩节段数较RVS组增加。结论与RVA起搏比较,RVS起搏有利于保持心肌电活动和机械收缩的同步性。     

实时三平面组织同步成像评价老年心肌梗死患者左心室内及心室间运动不同步

目的应用实时三平面组织同步成像技术评价老年心肌梗死患者左心室内及左右心室间运动不同步。方法选择2017年8月～2019年12月解放军总医院第一医学中心心内科临床确诊的急性心肌梗死患者71例,根据冠状动脉造影结果分为左冠状动脉病变组39例(共计546节段,其中左心室468节段),以左前降支和(或)左回旋支闭塞或严重狭窄为主;右冠状动脉病变组32例(共计448节段,其中左心室384节段),以右冠状动脉闭塞或严重狭窄为主。另随机选择健康志愿者30例作为对照组(共计420节段,其中左心室360节段)。测量各节段收缩期达峰时间(Ts),计算左心室12节段Ts的标准差和最大差值(Ts-SD、Ts-maxD)及左右心室收缩延迟(L-RV-D)。结果对照组左心室心肌运动表现为较均匀分布的绿色,极少数节段呈黄、绿色。左冠状动脉病变组和右冠状动脉病变组左心室心肌Ts彩色编码呈绿、黄、橙、红浓度分布不均。与对照组比较,左冠状动脉病变组左心室前壁、前侧壁、后侧壁、前间隔Ts明显升高,右冠状动脉病变组左心室下壁、后间隔和右心室侧壁Ts明显升高,差异有统计学意义(P0.05)。与对照组比较,左冠状动脉病变组和右冠状动脉病变组左心室12节段Ts-SD、Ts-maxD明显升高,且左冠状动脉病变组左心室12节段Ts-SD、Ts-maxD明显高于右冠状动脉病变组[(47.95±10.16)ms vs(35.62±7.03)ms,P0.05;(149.72±27.51)ms vs(107.55±19.23)ms,P0.05],L-RV-D明显低于右冠状动脉病变组[-(57.42±45.19)ms vs(48.26±29.57)ms,P0.05]。结论三平面组织同步成像能够定性、定量观测收缩运动延迟的心肌节段,定量评价左心室内及左、右心室间运动不同步。     

局部心肌存活状态与冠状动脉旁路移植术后远期心血管事件的关系

目的:探讨左心室各节段心肌存活状态与冠状动脉旁路移植术(CABG)后远期心血管事件之间的关系.方法:选择我院1999-01-01至2005-12-31行CABG且术前进行了核素心肌灌注和代谢单光子发射型计算机断层显像(SPECT)存活心肌试验的冠心病患者.排除院内死亡患者后共709人进入本研究.于术后定期进行随访.调阅上述患者核医学资料,以左心室17节段对术前心肌灌注和存活情况进行半定量评分并进一步得出量化结果,在此基础上计算出左心室5节段即前壁、间壁、侧壁、下后壁、心尖的灌注和存活情况.通过COX多因素分析的统计手段探寻各节段心肌灌注、存活情况与远期心脏不良事件之间的关系.结果:平均随访时间为(3.43±2.42)年.COX多元分析表明:左心室心尖、侧壁心肌存活的情况是远期心原性死亡的独立保护性因素;左心室前壁和侧壁的心肌存活情况是远期再入院的独立保护性因素;左心室前壁、侧壁心肌存活情况是远期复合终点事件的独立保护性因素.结论:左心室前壁和心尖部、侧壁的存活心肌情况是影响远期预后重要的独立相关因素.对于前壁部分心肌梗死的患者,注重前壁再血管化的同时,亦应充分注重侧壁的完全再血管化,这对于远期预后有重要意义.     

右室不同部位起搏对心肌收缩速度与位移的影响

目的采用组织多普勒成像(doppler tissue imaging,DTI)技术以及基于此技术的定量组织速度成像(quantitative tissue velocity imaging,QTVI)技术,定量测量右心室不同部位起搏时心肌各节段各时相运动速度与位移,进而分析不同部位起搏时心肌运动的变化。方法选择心尖部(RVA)起搏患者20例及间隔部(RVS)起搏患者20例,在静息状态下,同步记录磁频心电图,TVI模式下获取标准心尖四腔观、心尖二腔和左室长轴观的彩色组织多普勒图像并储存,应用心尖四腔观获取右室游离壁,室间隔和左室侧壁的时间-速度曲线,应用心尖二腔、左室长轴观获取左室前壁、下壁、左室前间隔和后壁的时间-速度曲线,测量各节段心肌基底段、中段的收缩速度及最大位移并分析。结果不同心肌节段的最大位移:RVA组与RVS组组内同一室壁均为基底段>中段(P<0.05),组间无统计学意义。不同心肌节段收缩峰值速度:在RVS组同一室壁均为基底段>中段(P<0.05),在RVA组仅左室前壁、下壁、前间隔、后壁为基底段>中段(P<0.05)。③RVS组与RVA组在起搏器植入一周时二维超声参数比较无统计学意义。结论不同部...     

面积应变定量评价无室壁运动异常的左心室缺血心肌的局部功能

目的利用三维斑点追踪成像面积应变评价常规超声心动图检查无明显节段性室壁运动异常的左心室缺血心肌的局部功能。方法本研究包括30例对照组和78例病例组,常规超声心动图检查左心室未见明显节段性运动异常,冠状动脉造影检查对照组所有分支狭窄均小于50%,病例组至少一条主要分支狭窄大于70%,利用三维斑点追踪成像测量左心室17节段的面积应变,比较缺血心肌节段和正常心肌节段面积应变的差异。结果左前降支供血区域前壁中间段、前间隔基底段与中间段、心尖部面积应变和平均面积应变较对照组明显减低(P0.05);左回旋支供血区域侧壁心尖段、后壁基底段与中间段面积应变和平均面积应变较对照组明显减低(P0.05);右冠状动脉供血区域下壁中间段与心尖段面积应变和平均面积应变较对照组明显减低(P0.05)。结论面积应变是可以作为定量评价左心室局部心肌功能的一种可用指标。     

应变率成像对正常儿童左心室心肌形变能力的定量研究

目的 定量研究我国正常儿童左心室心肌应变率参数及其随年龄变化的特点。方法 正常儿童92名,按年龄分为4组,应用GEVivid7超声仪及Q-analyze软件分别对各组儿童左心室侧壁、下壁、前壁、后壁及前、后室间隔心肌各节段进行应变率定量分析。结果 前3组（1～9岁）儿童左心室心肌应变率在各节段的分布不一致,差异有统计学意义;10～14岁组左心室心肌各节段收缩期和舒张早期应变率差异无统计学意义,呈均衡分布。结论 正常儿童左心室心肌各节段收缩期、舒张早期应变率随年龄增长逐渐趋向一致,10岁后分布模式与成人相似。     

25例心肌致密化不全病人的超声心动图特征分析

目的探讨超声心动图对心肌致密化不全(NCVM)病人的诊断价值。方法选取2013年10月—2015年10月接受超声心动图检查且诊断为NCVM的病人25例,其中男18例,女7例,年龄25岁~76岁。应用超声心动图实施多切面扫查,于心室舒张末期选择室壁最厚部位测量非致密化心肌厚度与致密化心肌厚度并计算两者比值(N/C),并且记录N/C2的节段数。结果 25例病人中,24例为左心室受累,1例为右心室受累,均观测到过度突出的肌小梁和深陷的小梁间隐窝,且心腔内的血流与肌小梁间的隐窝沟通。病变部位主要是左室心尖部(第17节段,100%)和左室侧壁中间段(第12节段,91%),其次为左室下壁中间段(第10节段,50%)和左室后壁中间段(第11节段,45%),室间隔中段及基底段的心肌结构未见明显异常。结论 NCVM以累及心尖部和左室侧壁中间段较常见,心肌致密化不全病人的超声心动图有明显特征性,是诊断心肌致密化不全的一种可靠检查方法。     

超声组织同步检测评价老年心肌梗死伴传导阻滞致左心室收缩不同步的研究

目的探讨超声组织同步显像技术评价老年心肌梗死患者不同传导阻滞所造成的心室各壁收缩不同步性的临床价值。方法选择老年心肌梗死患者52例,根据心电图传导阻滞情况分为右束支阻滞组14例,左束支阻滞组21例,房室传导阻滞组17例,采用超声组织同步显像技术对所有患者的3个左心室心尖长轴观的后间隔、侧壁、前壁、下壁、前间隔、后壁的基底段和中间段进行心肌收缩达峰时间(TTP)的检测,并进行比较与分析。结果右束支阻滞组TTP延长部位位于前间隔中段、基底段以及后间隔中段。左束支阻滞组TTP延长部位主要位于后间隔中段及基底段、左心室下壁中段及基底段、左心室后壁中段及基底段,前间隔中段及基底段、左心室前壁基底段TTP也轻度延迟。房室传导阻滞组TTP延长部位位于左心室侧壁中段及基底段、后间隔中段、左心室后壁中段及基底段。结论老年心肌梗死后伴不同传导阻滞所产生的左心室收缩不协调部位不同,超声组织同步显像技术能直观并且准确检测出左心室收缩不同步的部位,并进行量化。     

Dynamics of left ventricular longitudinal function in patients with arterial hypertension during therapy with angiotensin converting enzyme inhibitor moexipril

AIM: To assess left ventricular longitudinal systolic and diastolic function in patients with arterial hypertension in whom regression of left ventricular (LV) hypertrophy (LVH) occurred at the background of long term therapy with angiotensin converting enzyme inhibitor moexipril and hydrochlorothiazide. MATERIAL AND METHODS: Analysis was fulfilled in 44 patients (age 51.76+/-5.58 years) with regression of concentric LVH after 12 months of therapy. Complex examination included tissue Doppler imaging of myocardium and 24-hour blood pressure monitoring. RESULTS: Decrease of myocardial mass (mean 60.26+/-35.92 g) was accompanied with positive dynamics of parameters of 24-hour blood pressure monitoring. We observed decrease of ivrtm from fibrous annulus of mitral valve at the site of interventricular septum, posterior, inferior, and anterior LV walls--in 38 patients (86.4%); increase of motion velocity of mitral valve fibrous annulus during early LV filling at the site of interventricular septum, inferior and lateral LV walls--in 32 patients (72.72%); elevation of systolic velocity of mitral valve fibrous annulus movement at the site of interventricular septum-- in 21 patients (47.73%), and at the site of LV posterior wall--in 28 patients (63.64%). In 35 patients (79.54%) number of segments with e/a <1.0 decreased from 11.41+/-4.42 to 7.92+/-2.81 (p=0.01). In 39 patients (88.64%) number of segments with ivrt >90 ms decreased from 12.73+/-3.67 to 7.33+/-3.54 (p=0.008). In 34 patients (77.27%) regression of LVH was accompanied with elevation of systolic velocity in basal and middle segments of lateral and inferior left ventricular walls.     

超声心动图及标准化心肌分段法在心肌致密化不全诊断中的应用

目的 探讨超声心动图和标准化心肌分段法在心肌致密化不全诊断中的应用价值.方法 选择2000年8月至2008年8月经我院诊断的心肌致密化不全患者9例,男6例,女3例,年龄2～73岁,总结心肌致密化不全患者的超声心动图特征,并引用美国心脏协会建议的标准化心肌分段法,分析患者病变区域的分布特点.结果 9例患者的超声心动图均显示受累室壁由疏松的肌小梁和其间的深隐窝构成,隐窝内血流与心室腔相通.根据标准化心肌分段法,心尖顶段和心尖段下壁受累9例,心尖段侧壁和中部-心腔段下壁受累7例,中部-心腔段侧壁受累6例.心尖段和中部-心腔段室间隔、基底段下壁和侧壁及右心室心尖部受累均为1例.左心室前壁无受累.结论 超声心动图结合标准化心肌分段法对诊断心肌致密化不全具有重要价值,心尖顶段受累是超声诊断本病敏感而重要的依据之一.     

Pulsed Doppler Tissue Imaging for Assessment of Left Ventricular Systolic and Diastolic Synchronicity in Normal Subjects

Objectives To quantitatively analyze the longitudinal myocardial systolic and diastolic velocities and time intervals of the left ventricle in normal subjects, and to explore the value of pulsed Doppler tissue imaging (DTI) for the assessment of left ventricular systolic and diastolic synchronicity. Methods Twenty and six healthy subjects were studied by pulsed DTI. The septal and lateral, anterior and inferior walls of the left ventricle were displayed respectively, and basal and middle segments of each wall were selected for myocardial motion spectrum sampling. DTI parameters were; peak systolic myocardial velocity (s) , regional pre-ejection period (PEP), time to the peak of s wave (Ts), regional ejection time (ET); peak early diastolic velocity (e), peak late diastolic velocity (a), e/a ratio, time to the beginning of e wave (QE), time to the peak of e wave (Te) and regional isovolumic relaxation time (IVRT). Results The e and e/a were significantly different among basal segments, and s and e/a were significantly different among middle segments, with the highest value in lateral segments and the lowest value in septal segments. The s, e and a were all significandy higher in basal segments than middle segments. None of the systolic time intervals (PEP, Ts and ET) and diastolic time intervals (QE, Te and IVRT) were significantly different among basal segments and middle segments, neither were they when basal segment was compared with middle segment. Conclusions In normal subjects, the longitudinal myocardial systolic and diastolic velocities of the left ventricle are not homogeneous, but the contraction and relaxation are highly synchronized. Pulsed DTI can be used to quantitatively analyze the systolic and diastolic synchronicity of the heart.     

Comparison between tissue Doppler imaging and velocity-encoded magnetic resonance imaging for measurement of myocardial velocities, assessment of left ventricular dyssynchrony, and estimation of left ventricular filling pressures in patients with ischemic cardiomyopathy

Velocity-encoded magnetic resonance imaging (VE-MRI), commonly used to perform flow measurements, can be applied for myocardial velocity analysis, similar to tissue Doppler imaging (TDI). In this study, a comparison between VE-MRI and TDI was performed for the assessment of left ventricular dyssynchrony and left ventricular filling pressures. Ten healthy volunteers and 22 patients with heart failure secondary to ischemic cardiomyopathy underwent both VE-MRI and TDI. Longitudinal myocardial peak systolic and diastolic velocities and time to peak systolic velocity (Ts) were measured with both techniques at the level of left ventricular septum and lateral wall. To quantify left ventricular dyssynchrony, the delay in Ts between basal septum and lateral wall was calculated (SLD) and patients were categorized into 3 groups: minimal (SLD <30 ms), intermediate (SLD = 30 to 60 ms) and extensive (SLD >60 ms) left ventricular dyssynchrony. The ratio of transmitral E wave velocity and mitral annulus septal early velocity (E/E' ratio) was also assessed, and patients were divided into 3 groups: normal (E/E' <8), probably abnormal (E/E' = 8 to 15), and elevated (E/E' >15) left ventricular filling pressures. Excellent correlations were observed for peak systolic velocity and peak diastolic velocity (r = 0.95, p <0.001) measured with TDI and VE-MRI. A small bias (p <0.001) of -1.1 +/- 1.1 cm/s for peak systolic velocity and of -0.45 +/- 1.03 cm/s for peak diastolic velocity was noted between the 2 techniques. A strong correlation was also noted between Ts measured with TDI and VE-MRI (r = 0.97, p <0.001) without a significant difference. TDI and VE-MRI showed an excellent agreement for left ventricular dyssynchrony and left ventricular filling pressures classification with a weighted kappa of 0.96 and 0.91, respectively. In conclusion, TDI and VE-MRI are highly concordant and can be used interchangeably for the assessment of left ventricular dyssynchrony and filling pressures.     

The assessment of left ventricular systolic asynchrony in patients with primary hyperparathyroidism

Objectives: Primary hyperparathyroidism (PHP) is associated with a variety of cardiovascular disturbances such as left ventricular (LV) hypertrophy, diastolic cardiac dysfunction, and hypertension. LV asynchrony is defined as the loss of the simultaneous peak contraction of corresponding cardiac segments. The objective of this study was to assess systolic asynchrony in patients with overt hyperparthyroidism. Methods: Asynchrony was evaluated in 22 patients with PHP and 24 controls. All the patients and controls were subjected to a tissue synchronization imaging (TSI). The time to regional peak systolic tissue velocity (Ts) in LV by the six‐basal‐six‐midsegmental model was measured on ejection phase TSI images and four TSI parameters of systolic asynchrony were computed. Results: All TSI parameters of LV asynchrony increased in patients with PHP patients compared to the controls: the standard deviation (SD) of the 12 LV segments Ts (37.3 ± 20.6 vs. 21.5 ± 11.1, P = 0.01); the maximal difference in Ts between any 2 of the 12 LV segments (111.2 ± 59.8 vs. 70.2 ± 32.1, P = 0.01); the SD of the 6 basal LV segments (42.9 ± 36.4 vs. 18.5 ± 13, P = 0.003); and the maximal difference in Ts between any 2 of the 6 basal LV segments (89.6 ± 50.5 vs. 48 ± 31.1, P = 0.003). Conclusion: Patients with PHP show an evidence of LV asynchrony by TSI. Asynchrony may contribute to the harmful cardiovascular effects of PHP. (Echocardiography 2011;28:955‐960)     

定量组织速度成像对左束支传导阻滞左室收缩和舒张活动的评价

目的利用定量组织速度成像(QTVI)技术评价左束支传导阻滞左心室整体和局部收缩、舒张活动。方法测量20例完全性左束支传导阻滞(LBBB)患者和20名健康人于标准心尖四腔、两腔及心尖左室长轴切面获得的左心室6个室壁(后室间隔、侧壁、下壁、前壁、后壁、前间隔)基底段、中间段及心尖段同一心动周期各时相时间(ICT、IRT、ET等)以及长轴方向收缩期峰值速度(VS),舒张早期峰值速度(VE)、舒张晚期峰值速度(VA)。结果左束支传导阻滞患者ICT、IRT较正常对照组明显延长(P<0.01),ET缩短(P<0.05);SMPI、DMPI、MPI较对照组明显增高(P<0.01);同一室壁运动虽然存在一定梯度,但VS、VE明显减低。结论LBBB时,左心室内电机械活动不同步,收缩协同失调,引起局部心肌收缩舒张功能减低。     

超声组织同步成像技术评价右束支传导阻滞老年患者心室同步性的研究

目的 应用多普勒组织速度成像(TVI)技术评价老年冠心病右柬支传导阻滞患者心室的舒张和收缩的同步性. 方法 选择冠心病完全性右束支阻滞(CRBBB)老年患者35例及健康人31例(对照组)进行心肌组织同步显像研究,测量收缩期和舒张早期左、右心室基底段和中间段共14节段达到峰值时间(Ts和Te),并计算右心室2节段收缩达到峰值时间平均值(Ts-2-RV)及左心室12节段收缩及舒张达到峰值时间平均值(Ts-12-LV和Te-12-LV)、左心室12节段达到峰值时间的标准差(Ts-12-SD和Te-12-SD)和最大差值(Ts-diff和Te-diff).测量左心室收缩和舒张未内径和容积. 结果 (1)CRBBB组左、右心室14节段收缩期达到峰值时间较对照组延长(P<0.05或P<0.01),Ts-12-LV、Ts-12-SD、Ts-diff均长于对照组(P<0.01),CRBBB组中Ts-2-RV较Ts-12-LV延长,分别为(226.3±37.4)ms和(195.5±69.5)ms,差异有统计学意义(P<0.05);(2)CRBBB组左、右心室14节段舒张早期达到峰值时间与对照组差异无统计学意义,左心室Te-12-SD、Te-diff长于对照组(P<0.01). 结论 CRBBB患者心室收缩达到峰值时间延长,以右心室显著,收缩和舒张同步性较健康人差.     

Patients with ankylosing spondylitis have evidence of left ventricular asynchrony

Objectives: Ankylosing spondylitis (AS) is a chronic inflammatory disease that often leads to cardiovascular complications including aortic regurgitation and conduction disturbances. Left ventricular (LV) systolic asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. The aim of this study was to evaluate LV systolic asynchrony noninvasively in patients with AS by using tissue synchrony imaging (TSI). Methods: Asynchrony was evaluated in 77 AS patients (61 male, mean age 36.4 ± 10 years) and 40 controls (35 male, mean age 39.1 ± 8.2 years). All study population underwent a comprehensive echocardiographic evaluation including TSI. The time to regional peak systolic velocity (Ts) during the ejection phase in LV was measured from TSI images by the six‐basal and six‐midsegmental model, and four TSI parameters of systolic asynchrony were computed. Results: The baseline demographic and echocardiographic characteristics were similar between the patients enrolled and controls. All TSI parameters of LV asynchrony were prolonged in patients with AS compared to controls: the standard deviation (SD) of the 12 LV segments Ts (39.6 ± 19.6 vs. 24.7 ± 11.6, P < 0.001); the maximal difference in Ts between any 2 of the 12 LV segments (122.1 ± 52.9 vs. 82.2 ± 38.6, P < 0.001); the SD of the six basal LV segments (33.5 ± 20.2 vs. 23 ± 13.3, P = 0.008); and the maximal difference in Ts between any two of the six basal LV segments (84.6 ± 48.1 vs. 60.4 ± 34.6, P = 0.008). The asynchrony parameters were significantly correlated with index of myocardial performance (Tei index) and peak systolic mitral annular velocity. Conclusion: TSI showed presence of LV systolic asynchrony in patients with AS which may account for the cardiovascular complications of AS. (Echocardiography 2012;29:661‐667)     

组织多普勒评价右室不同部位起搏对左室收缩功能和同步性的影响

目的运用组织多普勒方法测量心脏机械活动的同步性,了解右室不同部位起搏后左心室同步性和收缩功能的即刻变化。方法选择拟行心内电生理检查的患者9例,排除器质性心脏病。在右室心尖部、右室低位室间隔、右室流出道游离壁和间隔部按随机的顺序行房室顺序起搏,采集彩色编码的组织多普勒图像进行下线分析。计算整体收缩振幅（global systolic contraction amplitude,GSCA）和16节段峰值收缩速度和位移达峰时间的标准差Ts-SD与Tdis-SD。结果右室流出道游离壁或间隔部起搏的GSCA显著高于右室心尖部或低位间隔起搏时,但低于基础状态（P〈0．05）。右室心尖部起搏与右室流出道间隔部起搏的节段收缩位移比较显示,右室心尖部起搏时左室侧壁、后壁和下壁的平均位移显著降低（P〈0．05）,余节段差异无统计学意义。右室心尖部或低位室间隔起搏时,组织位移曲线由正常时的单峰变为双峰或三峰,且舒张末期出现负相位移,组织速度曲线出现等容收缩峰增高。Tdis-SD和Ts-SD在右室各部位起搏时均较基础状态时显著降低（P〈0．01）,但各部位起搏之间的差异无统计学意义。结论右室起搏即刻导致左心室内收缩非同步现象和左心收缩功能的下降。右室流出道起搏较右室心尖部起搏和低位室间隔起搏对左室收缩功能的影响小,是一种较为理想的起搏部位。