Botvinick Elias, Davis Jesse, Dae Michael, O'Connell John, Schechtmann Norberto, Abbott Joseph, Morady Fred, Lanzer Peter, Iskikian John, Scheinman Melvin
Department of Medicine, University of California San Francisco, San Francisco, California 94143, USA.
JACC Cardiovasc Imaging. 2008 Sep;1(5):605-13. doi: 10.1016/j.jcmg.2008.05.013.
In an effort to better understand the clinical effects of ventricular tachycardia (VT), we sought to characterize function and conduction during VT in patients.
The image evaluation of VT has been limited by the lack of technical tools and its often-dramatic hemodynamic effect. Objective bedside imaging of VT-induced changes in contraction pattern, synchrony, and volumes has never been performed but could aid in the understanding of rhythm tolerance.
Equilibrium radionuclide angiography (ERNA) with phase analysis was performed during the course of 32 VT rhythms. Left ventricular ejection fraction, wall motion, synchrony, relative volumes, and exit sites were compared in 13 patients tolerant to VT (Group I) and 9 intolerant to VT (Group II).
The ERNA VT exit site agreed with the results of electrocardiogram in 26 of 32 (81%) cases and with electrophysiologic study in 16 of 19 (84%) cases (both p < 0.05). A greater rate (157 vs. 130, p < 0.0001) accompanied VT intolerance, but the exit site in 4 patients with multiple VT patterns also appeared important to tolerance. Left ventricular ejection fraction, similar in both groups in sinus rhythm, decreased with VT in Groups I (28 to 19) and II (31 to 15), both p<0.03, with a greater relative decrease in LV ejection fraction, LV stroke volume (65% vs. 45%, p < 0.01), cardiac output (30% vs. 2%), and LV end-diastolic volume (36% vs. 27%, both p < 0.001), in Group II. The standard deviation of LV phase angle (Ø) was the only parameter which differed between Groups I and II (35 vs. 45, p < 0.01) in sinus rhythm. With VT, wall motion deteriorated generally, but with greater standard deviation LVØ, p < 0.05, and dyssynchrony in Group II. Ventricular tachycardia induced 14 functional aneurysms, often adjacent to VT exit sites.
A challenging bedside imaging protocol evaluated VT-induced changes. We found that the use of ERNA demonstrated function, synchrony, and volume differences between tolerant and intolerant VT rhythms, delineated the contraction pattern, and localized exit sites.
为了更好地理解室性心动过速（VT）的临床效果，我们试图对患者室性心动过速期间的功能和传导进行特征描述。
室性心动过速的影像评估一直受到技术工具的缺乏及其通常显著的血流动力学效应的限制。从未进行过对室性心动过速引起的收缩模式、同步性和容量变化的客观床边成像，但这有助于理解心律耐受性。
在32次室性心动过速节律过程中进行了带相位分析的平衡放射性核素血管造影（ERNA）。比较了13例对室性心动过速耐受的患者（第一组）和9例对室性心动过速不耐受的患者（第二组）的左心室射血分数、壁运动、同步性、相对容量和出口部位。
在32例中的26例（81%）中，ERNA室性心动过速出口部位与心电图结果一致，在19例中的16例（84%）中与电生理研究结果一致（两者p<0.05）。室性心动过速不耐受时心率更高（157对130，p<0.0001），但4例有多形性室性心动过速模式的患者的出口部位对耐受性似乎也很重要。两组在窦性心律时左心室射血分数相似，第一组（从28降至19）和第二组（从31降至15）在室性心动过速时均下降，两者p<0.03，第二组左心室射血分数、左心室每搏量（65%对45%，p<0.01）、心输出量（30%对2%）和左心室舒张末期容积（36%对27%，两者p<0.001）的相对下降更大。左心室相位角（Ø）的标准差是两组在窦性心律时唯一不同的参数（35对45，p<0.01）。发生室性心动过速时，壁运动一般恶化，但第二组左心室Ø标准差更大，p<0.05，且存在不同步。室性心动过速诱发了14个功能性动脉瘤，常邻近室性心动过速出口部位。
一项具有挑战性的床边成像方案评估了室性心动过速引起的变化。我们发现，使用ERNA显示了耐受和不耐受室性心动过速节律之间的功能、同步性和容量差异，描绘了收缩模式，并确定了出口部位。
