利用组织多普勒评价左束支阻滞患者心室内不同步

利用组织多普勒测量不同步指数评价左束支阻滞 (LBBB)患者心室内不同步 ,对 15例LBBB患者 (LBBB组 )和 15例正常人 (对照组 )左心室各壁基底、中间、心尖段 ,获取组织多普勒速度曲线 ,分别测量QRS波起点到S波起点的时间 (Q Sb) ,计算心室内同步性指数 (TSI)和各室壁壁内的同步性指数 (RSI)。结果 :LBBB组患者各壁Q Sb延长 ,以室间隔、前壁、下后壁显著 ;TSI和左室室间隔的RSI较对照组明显增高 (分别为 30 .86± 9.78msvs 14 .81± 6 .89ms;2 7.13± 16 .82msvs 12 .19± 10 .70ms ,P均 <0 .0 1)。结论 :LBBB时左室激动顺序异常 ,左室各壁各节段出现不同程度的收缩延迟 ,心室内不同步明显 ;同一室壁内的不同步 ,以室间隔最显著。

Assess Intraventricular Dyssynchrony in Left Bundle Branch Block Patients by Doppler Tissue Imaging

To observe intraventricular dyssynchrony in left bundle branch block(LBBB) patients by Doppler tissue imaging(DTI), left ventricular regional myocardium of 15 LBBB patients and 15 normal persons(control group) were assessed. After dynamic images were collected and information were analyzed off-line, left ventricular myocardial velocity cures were acquired along long axis asynchronously in basal, mid, apical of different walls, the duration from the beginning of ECG QRS wave to the beginning of S wave (Q-Sb) were measured. Furthermore, total synchronicity index (TSI) of left ventricle and regional synchronicity indexes (RSI) in different walls were calculated. Results: Q-Sb of different walls were longer in LBBB group than control group, especially in septal, anterior, inferior and posterior walls; total synchronicity index and regional synchronicity indexes in septal wall were significantly higher in LBBB group than control group(30.86±9.78 ms vs 14.81±6.89 ms;27.13±16.82 ms vs 12.19±10.70 ms,P<0.01). Conclusion: Abnormal left ventricular activation sequence during LBBB caused delayed contraction with different degrees in different walls of left ventricle and intraventricular dyssynchrony, especially in septal walls.