Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy.
Department of Engineering and Architecture, University of Trieste, P. Europa 1, 34127 Trieste, Italy.
Europace. 2017 Nov 1;19(11):1833-1840. doi: 10.1093/europace/euw331.
To characterize the effect of multipoint pacing (MPP) compared to biventricular pacing (BiV) on left ventricle (LV) mechanics and intraventricular fluid dynamics by three-dimensional echocardiography (3DE) and echocardiographic particle imaging velocimetry (Echo-PIV).
In 11 consecutive patients [8 men; median age 65 years (57-75)] receiving cardiac resynchronization therapy (CRT) with a quadripolar LV lead (Quartet,St.Jude Medical,Inc.), 3DE and Echo-PIV data were collected for each pacing configuration (CRT-OFF, BiV, and MPP) at follow-up after 6 months. 3DE data included LV volumes, LV ejection fraction (LVEF), strain, and systolic dyssynchrony index (SDI). Echo-PIV was used to evaluate the directional distribution of global blood flow momentum, ranging from zero, when flow force is predominantly along the base-apex direction, up to 90° when it becomes transversal. MPP resulted in significant reduction in end-diastolic and end-systolic volumes compared with both CRT-OFF (P = 0.02; P = 0.008, respectively) and BiV (P = 0.04; P = 0.03, respectively). LVEF and cardiac output were significant superior in MPP compared with CRT-OFF, but similar between MPP and BiV. Statistical significant differences when comparing global longitudinal and circumferential strain and SDI with MPP vs. CRT-OFF were observed (P = 0.008; P = 0.008; P = 0.01, respectively). There was also a trend towards improvement in strain between BiV and MPP that did not reach statistical significance. MPP reflected into a significant reduction of the deviation of global blood flow momentum compared with both CRT-OFF and BiV (P = 0.002) indicating a systematic increase of longitudinal alignment from the base-apex orientation of the haemodynamic forces.
These preliminary results suggest that MPP resulted in significant improvement of LV mechanics and fluid dynamics compared with BiV. However, larger studies are needed to confirm this hypothesis.
通过三维超声心动图（3DE）和超声心动图粒子成像测速（Echo-PIV），比较多点起搏（MPP）与双心室起搏（BiV）对左心室（LV）力学和室内流体动力学的影响。
在 11 例连续接受心脏再同步治疗（CRT）的患者中（8 例男性；中位年龄 65 岁（57-75 岁）），使用四极 LV 导线（ Quartet，St. Jude Medical，Inc.），在 6 个月后随访时，为每种起搏配置（CRT-OFF、BiV 和 MPP）收集 3DE 和 Echo-PIV 数据。3DE 数据包括 LV 容积、LV 射血分数（LVEF）、应变和收缩不同步指数（SDI）。Echo-PIV 用于评估整体血流动量的方向分布，范围从 0 度（当血流力主要沿基底-心尖方向时）到 90 度（当它变为横向时）。与 CRT-OFF（P=0.02；P=0.008）和 BiV（P=0.04；P=0.03）相比，MPP 导致舒张末期和收缩末期容积显著减少。与 CRT-OFF 相比，MPP 时 LVEF 和心输出量显著更高，但 MPP 与 BiV 之间无显著差异。与 MPP 相比，MPP 与 CRT-OFF 相比，观察到整体纵向和圆周应变和 SDI 的统计学显著差异（P=0.008；P=0.008；P=0.01）。BiV 和 MPP 之间的应变也有改善的趋势，但无统计学意义。与 CRT-OFF 和 BiV 相比，MPP 导致整体血流动量的偏差显著减少（P=0.002），表明血流力的基底-心尖方向的纵向对准程度系统性增加。
这些初步结果表明，与 BiV 相比，MPP 可显著改善 LV 力学和流体动力学。然而，需要更大的研究来证实这一假设。
