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目的应用组织多普勒研究心脏再同步化治疗(CRT)术后 A-V、V-V 间期优化对心脏同步性能及心功能的影响,探索 A-V、V-V 间期优化在增强 CRT 临床疗效中的作用。方法 32例慢性心力衰竭患者接受 CRT 治疗,手术后7天、3个月、6个月进行 A-V、V-V 间期优化,观察心脏同步性和心功能变化。采用彩色超声诊断仪进行图像采集及下线分析。结果经观察,术后7天、3个月、6个月的 A-V 间期需行优化的例数分别为28例、10例、6例,V-V 间期需行优化的例数分别为29例、6例、5例。与 CRT 术前相比:CRT 治疗术后未优化时的左室12节段组织速度达峰时间标准差明显改善[(68.8±26.4)ms 与(41.6±23.1)ms,P<0.01],左室射血分数增加[(28±4)%与(31±3)%,P<0.05],主动脉瓣前向血流速度时间积分增加[(13.6±3.1)cm 与(15.5±4.3)cm,P<0.05],舒张早期跨二尖瓣血流峰速和舒张早期心肌组织运动峰速的比值下降(13.1±5.3与9.3±4.3,P<0.05),左室舒张充盈时间延长[(313.2±93.6)ms 与(368.6±97.1)ms,P<0.05]。与术后未优化时相比:术后7天优化心脏同步性指标进一步改善(P<0.05),心功能指标无明显改变;术后3个月、6个月优化与术后7天优化相比,心脏同步性指标无明显改变,P>0.05;术后6个月优化的左室射血分数增加,左室舒张充盈时间延长,P<0.01。结论 CRT 术后7天,A-V、V-V 间期优化治疗改善心脏同步指标;术后6个月优化进一步改善心功能。
Objective To investigate the effect of A-V and V-V interval optimization on cardiac synchrony and cardiac function after cardiac resynchronization therapy (CRT) by tissue Doppler and to explore the role of A-V and V-V interval optimization in enhancing the clinical curative effect of CRT. Methods Thirty-two patients with chronic heart failure were treated with CRT. The A-V and V-V intervals were optimized at 7 days, 3 months and 6 months after operation. Cardiac synchronization and cardiac function were observed. Color ultrasound scanner for image acquisition and off-line analysis. Results The number of patients who underwent AV interval optimization at 7 days, 3 months and 6 months postoperatively was 28, 10 and 6, respectively. The number of cases requiring optimization during the VV interval was 29 , 6 cases, 5 cases. Compared with preoperative CRT, the standard deviation of peak tissue velocity in 12 segments of left ventricle was significantly improved after CRT was not optimized [(68.8 ± 26.4) ms and (41.6 ± 23.1) ms, P <0.01], left The ejection fraction of the aorta increased [(28 ± 4)% vs (31 ± 3)%, P <0.05], and the time integral of the aortic valve forward blood flow increased [(13.6 ± 3.1) cm and (15.5 ± 4.3) cm , P <0.05]. The ratio of mitral flow peak velocity and early diastolic myocardial peak velocity decreased significantly at early diastole (13.1 ± 5.3 vs. 9.3 ± 4.3, P <0.05) and left ventricular diastolic filling time prolonged [(313.2 ± 93.6) ms and (368.6 ± 97.1) ms, P <0.05]. Compared with the unoptimized group, the indexes of cardiosynchrony improved further on the 7th day after operation (P <0.05), while the indexes of cardiac function did not change significantly. The optimizations at 3 and 6 months after operation and those on the 7th day after operation The indexes of cardiac synchronicity did not change significantly (P> 0.05). The optimized left ventricular ejection fraction increased at 6 months after operation and the left ventricular diastolic filling time prolonged (P <0.01). Conclusions 7 days after CRT, the optimal treatment of A-V and V-V intervals can improve cardiac synchronization. After 6 months, the cardiac function can be improved further.