不同心脏起搏模式对右室长轴应变和肺血管阻力的急性影响

目的探讨不同心脏起搏模式对右室长轴应变与肺血管阻力的即刻影响。方法具有正常房室传导顺序并已植入全自动频率自适应双腔起搏器的病窦综合征患者45例,所有患者随机在心房起搏心室起搏(APVP)、心房起搏心室感知(APVS)和心房感知心室感知(ASVS)起搏模式下起搏90 min,然后再随机交叉进行其余两种模式起搏90 min,分别在不同模式下行超声心动图检查,记录右室功能、右室长轴应变及血流动力学参数。结果与APVP模式比较,ASVS模式的右室心肌做功指数、肺血管阻力(PVR)、肺动脉血流加速度及心室异常舒张模式较低,而三尖瓣环收缩期运动幅度、肺动脉血流加速时间及血流速度积分较高(P0.05)。与APVS模式比较,ASVS模式的肺动脉血流加速度较低(P=0.042),血流加速时间较高(P=0.01)。与APVP模式比较,APVS模式的PVR较低(P=0.016),肺动脉血流速度积分较高(P=0.034)。三种起搏模式两两比较,其右室游离壁长轴应变差异有统计学意义(P0.05)。不同起搏模式下,右室心肌做功指数和右室游离壁长轴应变呈正相关。结论右室长轴应变决定右室功能状态,尽管ASVS和APVS模式未促进PVR的增加,但更生理性的ASVS模式能更好地保存右室功能。

Acute effects on right ventricular longitudinal mechanics and pulmonary vascular resistance induced by different cardiac pacing mode

Objective To investigate the acute effects on right ventricular（RV） longitudinal mechanics and pulmonary vascular resistance （PVR） in different cardiac pacing mode using echocardiography.nethods Forty-five sick sinus syndrome patients with normal atrioventricular conduction and previously implanted DDDR cardiac pacemakers. All patients were randomly asigned into atrial pacing ventricular pacing（APYP）, atrial pacing ventricular sensing（APVS） and artial sensing ventricular sensing（ASVS） modes pacing for 90 min, and then crossed over the other two modes pacing for 90 min, the echocardiographic examination was performed for all patients, the parameters were recorded, including the RV function, RV longitudinal strain and hemodynamics in different mode.Results Compared with APVS mode, ASVS mode had lower RV myocardial performance index, PVR and abnormal diastolic pattern, higher tricuspid annular plane systolic excursion, pulmonary flow acceleration time and blood flow velocity integral（P〈 0.05）.Compared with APVS mode,ASVS mode has lower pulmonary flow acceleration velocity（P=0.042）, higher pulmonary flow acceleration time （P=0.01）. Compared with APVP mode, APVS mode has lower PVR （P=0.016）, higher pulmonary flow acceleration time（ P=0.034 ）. The RV myocardial performance index were positively correlated with RV longitudinal strain free wall in ASVS,APVS and APVP mode.Conclusion RV longitudinal strain free wall is closely related to RV function, ASVS and APVS mode did not promote PVR increase, and ASVS is better in protecting RV function in three pacing modes.