Kerwin W F, Botvinick E H, O'Connell J W, Merrick S H, DeMarco T, Chatterjee K, Scheibly K, Saxon L A
Department of Medicine, University of California, San Francisco, USA.
J Am Coll Cardiol. 2000 Apr;35(5):1221-7. doi: 10.1016/s0735-1097(00)00555-6.
To measure ventricular contractile synchrony in patients with dilated cardiomyopathy (DCM) and to evaluate the effects of biventricular pacing on contractile synchrony and ejection fraction.
Dilated cardiomyopathy is characterized by abnormal ventricular activation and contraction. Biventricular pacing may promote a more coordinated ventricular contraction pattern in these patients. We hypothesized that biventricular pacing would improve synchrony of right ventricular and left ventricular (RV/LV) contraction, resulting in improved ventricular ejection fraction.
Thirteen patients with DCM and intraventricular conduction delay underwent multiple gated equilibrium blood pool scintigraphy. Phase image analysis was applied to the scintigraphic data and mean phase angles computed for the RV and LV. Phase measures of interventricular (RV/LV) synchrony were computed in sinus rhythm and during atrial sensed biventricular pacing (BiV).
The degree of interventricular dyssynchrony present in normal sinus rhythm correlated with LV ejection fraction (r = -0.69, p < 0.01). During BiV, interventricular contractile synchrony improved overall from 27.5 +/- 23.1 degrees to 14.1 +/- 13 degrees (p = 0.01). The degree of interventricular dyssynchrony present in sinus rhythm correlated with the magnitude of improvement in synchrony during BiV (r = 0.83, p < 0.001). Left ventricular ejection fraction increased in all thirteen patients during BiV, from 17.2 +/- 7.9% to 22.5 +/- 8.3% (p < 0.0001) and correlated significantly with improvement in RV/LV synchrony during BiV (r = 0.86, p < 0.001).
Dilated cardiomyopathy with intraventricular conduction delay is associated with significant interventricular dyssynchrony. Improvements in interventricular synchrony during biventricular pacing correlate with acute improvements in LV ejection fraction.
测量扩张型心肌病（DCM）患者的心室收缩同步性，并评估双心室起搏对收缩同步性和射血分数的影响。
扩张型心肌病的特征是心室激活和收缩异常。双心室起搏可能会促使这些患者形成更协调的心室收缩模式。我们假设双心室起搏会改善右心室和左心室（RV/LV）收缩的同步性，从而提高心室射血分数。
13例患有DCM和室内传导延迟的患者接受了多门控平衡血池闪烁扫描。将相位图像分析应用于闪烁扫描数据，并计算右心室和左心室的平均相位角。在窦性心律和心房感知双心室起搏（BiV）期间计算心室间（RV/LV）同步性的相位测量值。
正常窦性心律时存在的心室间不同步程度与左心室射血分数相关（r = -0.69，p < 0.01）。在BiV期间，心室间收缩同步性总体上从27.5±23.1度改善到14.1±13度（p = 0.01）。窦性心律时存在的心室间不同步程度与BiV期间同步性改善的幅度相关（r = 0.83，p < 0.001）。在BiV期间，所有13例患者的左心室射血分数均增加，从17.2±7.9%增加到22.5±8.3%（p < 0.0001），并且与BiV期间RV/LV同步性的改善显著相关（r = 0.86，p < 0.001）。
伴有室内传导延迟的扩张型心肌病与显著的心室间不同步相关。双心室起搏期间心室间同步性的改善与左心室射血分数的急性改善相关。
