孫雅萍 史浩穎 吳雪英 王菊芳 顔青 劉健 上海交通大學附屬第一人民醫院心超室（上海，200080，中國）
摘要 目的 觀察心電圖傳導阻滯類型與超聲心動圖機械不同步的關係。方法 研究慢性心力衰竭（心衰）患者93例, QRS間期≥120ms，LVEF<40%，其中完全性左束支傳導阻滯（CLBBB）51例，完全性右束支傳導阻滯（CRBBB）20例，非左束支或右束支的室內傳導阻滯（IVCD）22例。測量QRS間期幷應用超聲心動圖參數評價其機械收縮不同步性。結果 在心衰伴CLBBB中，82％患者左心室射血前時間（LVPT）>140ms，73％患者左右心室間收縮時間差>40ms，80％患者左室12節段的收縮速度達峰時間標準差（Ts-SD）>32.6ms。在QRS間期相當時，CLBBB組的室間隔-後壁運動延遲時間（SPWMD）、LVPT、左右心室間收縮時間差、Ts-SD顯著大于CRBBB組。CLBBB組的LVPT顯著大于IVCD組。結論 心衰合幷CLBBB患者的左室機械收縮不同步程度高于LVEF及QRS間期水平相同的其他類型傳導阻滯心衰患者，心室機械收縮不同步的程度與電活動傳導阻滯類型相關。
關鍵詞 心力衰竭 心臟機械不同步 超聲心動圖描記術 組織多普勒
The mechanical dyssynchrony and intra-ventricular conduction delay in patients with congestive heart failure
SUN Yaping, SHI Haoying, WANG Jufang, YAN Qing, WU Xueying, LIU Jian.Department of cardiology, Shanghai First People’s Hospital Affiliated to Jiaotong University (Shanghai, 200080, China)
Abstract Objectives To investigate the reletion between the type of intra-ventricular conduction delay and mechanical dyssynchrony. Methods We studied 93 chronic heart failure patients. All the patients underwent conventional echocardiography and tissue Doppler imaging. Patients with complete left bundle branch block (CLBBB), complete right bundle branch block (CRBBB) and intra-ventricular conduction delay without bundle branch block were compared. Results The Left ventricular pre-ejection time (LVPT) was >140ms in 82% of patients with CLBBB and the intra-ventricular dyssynchrony parameter (Ts-SD) was >32.6ms in 80% patients. When the QRS duration was comparable in each group, the septal to posterior wall motion delay, LVPT and Ts-SD were all significantly higher in patients with CLBBB than CRBBB. Only LVPT was significantly higher in patients with CLBBB compared with patients with intra-ventricular conduction delay without bundle branch block. Conclusions The type of intra-ventricular conduction delay correlated with mechanical dyssynchrony.
Keywords heart failure; mechanical dyssynchrony; echocardiograph; tissue doppler
