完全性左束支传导阻滞合并或不合并心力衰竭患者的心室内同步性比较

目的应用组织多普勒技术评价完全性左束支阻滞（CLBBB）合并或不合并心力衰竭患者心室内收缩及舒张同步性情况。方法选取16例CLBBB患者且左室射血分数（LVEF）≥50%（病例Ⅰ组）、14例CLBBB患者且LVEF〈50%（病例Ⅱ组）及正常对照组20例受检者心尖四腔心、两腔心和心尖长轴三个切面中左室6个壁12个取样点的定量组织速度成像（Q-TVI）曲线,测量从心电图QRS波群起点至收缩期速度峰值和舒张早期速度峰值的时限Ts和Te。结果病例Ⅰ组、病例Ⅱ组左室内不同步性运动参数左心室12个心肌节段Ts最大差值（Max-△Ts）、左心室12个心肌节段Te最大差值（Max-△Te）、每位入选者12节段心肌Ts的标准差（Ts-SD）、每位入选者12节段心肌Te的标准差（Te-SD）较对照组均有延长,且病例Ⅱ组较病例Ⅰ组延长更明显（P〈0.05或P〈0.01）。病例Ⅰ组后间隔的左心室同一壁内2个节段间Ts差值（Intra-△Ts）及左心室同一壁内2个节段间Te差值（Intra-△Te）较对照组有明显延迟,余5个壁无明显差异,而病例Ⅱ组6个壁的Intra-△Ts和Intra-△Te值均明显大于对照组（P〈0.05或P〈0.01）。结论CLBBB合并或不合并心衰的患者存在着心室内电-机械收缩、舒张运动的不同步。CLBBB不合并心衰患者仅后间隔存在电-机械收缩、舒张运动的不同步,而合并心衰的患者左心室6个壁均存在电-机械收缩及舒张运动的不同步。

Comparison of synchrony of ventricle in patients of complete left bundle branch block with or without heart failure

Objective To evaluate the synchrony of ventricle in patients of CLBBB with or without heart failure by using tissue Doppler imaging.Methods 16 CLBBB patients without heart failure(LVEF≥50%)(group Ⅰ),14 CLBBB patients with heart failure(LVEF<50%)(group Ⅱ) and 20 healthy adults(control group) were brought into the analysis.The 12-segment of left ventricular 6 walls and basal segment were obtained in apical four-chamber,two-chamber,and long-axis view by using quantitative tissue velocity imaging(Q-TVI).The beginning of QRS to peak systolic velocity(Ts) and early diastolic velocity(Te) also were measured of the subjects.Results The parameters of Max-△Ts,Max-△Te,Ts-SD,Te-SD in group Ⅰand group Ⅱwere significantly longer than those in control group,while those in group Ⅱ were significantly longer than those in group Ⅰ(P < 0.05 or P < 0.01).The parameters of Intra-△Ts and Intra-△Te in group I were significantly longer than those in control group in septal wall,and the time of 6 walls’ in group Ⅱwere significantly longer than those in control group(P < 0.05 or P < 0.01).Conclusion The patients of CLBBB with or without heart failure can cause inter-atrial asynchronism,and the patients of CLBBB without heart failure can cause asynchronism in septal wall.The patients with heart failure cause asychronism in 6 walls.