不同激动顺序犬左心室收缩期跨壁扭转运动的超声实验研究

目的 应用斑点追踪成像技术评价不同电机械激动顺序下收缩期左室跨壁扭转运动特征.方法 5只开胸比格犬模型,分别在基础(BASE),右心耳(RAA)、右室心尖(RVA)、左室侧壁(LVL)和左室心尖(LVA)起搏状态采集左室心尖、基底短轴和四腔心图像.QLAB软件分析短轴切面心内膜下、心外膜下和整体旋转角度(RA)及节段角位移(AE),计算左室扭转及射血分数(EF).结果 ①RAA组心内膜下、心外膜下和整体扭转,基底和心尖水平心内膜下、心外膜下和整体RA及AE与BASE组间差异无统计学意义(P>0.05);②RVA组心内膜下、心外膜下和整体扭转及LVA组心内膜下和整体扭转均小于RAA组(P<0.05);RVA和LVA组基底心内膜下、心外膜下和整体RA均小于RAA组(P<0.05);③心室起搏后起搏位点相邻节段心肌AE小于RAA组(P<0.05);④BASE状态心内膜下扭转大于心外膜下(P<0.05),起搏仅呈心内膜下扭转大于心外膜下趋势(P>0.05);⑤BASE组与RAA组心外膜下和整体扭转与左室EF呈正相关;基底心内膜下、心外膜下和整体RA与左室EF呈正相关.结论 RVA及LVA起搏明显抑制左室跨壁扭转运动;正常激动顺序下左室整体及外膜下心肌扭转和基底旋转运动与左室EF关系密切.

Ultrasonic experimental research of systolic left ventricular transmural torsion in different electro-mechanical patterns: a canine model

Objective To evaluate the mechanical characteristics of systolic left ventricular(LV) transmural torsion in different LV electro-mechanical patterns using speckle tracking imaging. Methods Five open-chest canine models were employed for the acquirement of the basal, apical short-axis and four-chamber views of LV during baseline(BASE) and right atrial appendage(RAA), right ventricular apical (RVA), left ventricular lateral wall (LVL) and left ventrieular apical (LVA) pacing. Subendocardial (subend),subepicardial(subepi) and bulk rotation angle(RA) and segmental angle excursion(AE) at basal and apical level were analyzed using a dedicated workstation. LV torsion at different layers and bulk and global LV ejection fraction (EF) were calculated. Results ① There were no significant difference of transmural torsion and RA at basal and apical level between BASE and RAA pacing (P>0.05);② LV torsion of subend, subepi and bulk during RVA pacing were lower than those during RAA pacing(P0.05);LV torsion of subend and bulk during LVA pacing were lower than those during RAA pacing(P0.05);LV RA of subend,subepi and bulk at basal level during RVA and LVA pacing were lower than those during RAA pacing (P<0.05); ③ For normal electro-mechanical pattern, LV torsion of subend were significant higher than that of subepi(P<0.05), there only were a higher tendency for all pacing models (P>0.05); ④AE of segments near the pacing site decreased during different ventricle paeings (P<0.05); ⑤At BASE and during RAA pacing, LV bulk and subepi torsion were positively correlated to EF; RA of subend,subepi and bulk at basal level were positively correlated to EF. Conclusions LV transmual torsion are significantly depressed during RVA and LVA pacing. There is a spatial co-relationship between LV EF and torsion and rotation of bulk and subepi at basal level in normal LV electro-mechanical patterns.