左捆枝节奏更好地保持心室机械同步比右心室节奏:一个两个中心的研究
Yankai Mao1,2, Jürgen Duchenne2, Yuan Yang1
1Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
European heart journal. Cardiovascular Imaging
|November 7, 2023
概括
与右心室节奏相比,左束枝节奏 (LBBP) 更好地保持左心室 (LV) 机械同步和功能. LBBP导致LV机械失调减少,随着时间的推移保持更好的LV功能.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏机械学 心脏机械学
背景情况:
- 众所周知,左束枝节奏 (LBBP) 能够改善电同步,而不是右心室节奏 (RVP).
- 与RVP相比,LBBP对左心室 (LV) 机械同步和功能的影响仍然不太清楚.
研究的目的:
- 调查LBBP是否保持LV机械同步性,并且比RVP更有效地运行.
- 为了比较LBBP和RVP对机械异步和LV性能的影响.
主要方法:
- 招募了60名需要节奏调节的急性心脏病患者,随机分配到LBBP (n=31) 或RVP (n=29).
- 心声学评估了在基线,植入后和1年随访时的机械同步 (侧壁-七面壁工作差异) 和LV功能 (射出分数,全球纵向应变).
- 分析包括隔膜闪光,顶端摇摆和应变模式.
主要成果:
- 在1年的随访中,与RVP相比,LBBP显示侧壁-七面壁工作差异明显较小 (439 mmHg·%与1253 mmHg·%,P<0.01).
- RVP与增加的隔膜闪,顶端摇和先进的应变模式有关.
- 一年后,LV喷射率和全球纵向应变与RVP (ΔLVEF: -7.4%,ΔLVGLS: -4.8%) 相比,与LBBP (ΔLVEF: 0.3%,ΔLVGLS: -1.4%) 降低了更多 (P<0.01).
- 增加的机械失调独立与不良的LV重塑和功能障碍相关.
结论:
- 与RVP相比,LBBP会诱导较少的左心室机械失调.
- LBBP比RVP更好地保护左心室功能,这可能是由于更多的生理电导.
- LBBP代表了一种潜在的优越节奏策略,用于维持心脏机制和功能.
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