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目的:运用组织多普勒和实时三维超声心动图技术分析体表心电图I导联呈宽M型左束支传导阻滞(LBBB)患者的左心室同步性。方法:按体表心电图I导联QRS波是否呈宽M型将46例LBBB患者分为LBBBM型组(20例)和LBBB非M型组(26例),并选择正常对照组40例。用组织多普勒技术分别测定2组患者左心室心肌12个节段的收缩达峰时间(TS),并计算达峰时间差(△TS);以△TS>65ms为标准,判断心肌同步性。用实时三维超声测定左室舒张末容积、收缩末容积和左室射血分数,并应用Qlab定量分析软件,对所有患者的实时三维超声图像对三维数据库进行定量分析,测得到左室整体容积曲线、17节段容积曲线、17节段的平均最大容积(Vmax)及其标准差(Vmax-SD)、平均最小容积(Vmin)及其标准差(Vmin-SD)、最小容积点距离心电图Q波起始点的平均时间(T)及其标准差(T-SD)、17个节段中的最小容积点距离心电图Q波起始点的最大时间差(Tmax)。结果:①以同一心肌壁内不同节段间的△TS>65ms为心肌收缩不同步标准,计算LBBBM型组患者中左心室心肌非同步化的发生率为85.00%(17/20),明显高于LBBB非M型的57.69%(15/26),P<0.05;②LBBBM型组与LBBB非M型组间Vmin-SD、T-SD和Tmax差异均有统计学意义(P<0.05~0.01)。结论:采用组织多普勒超声心动图与实时三维超声心动图证实,在体表心电图I导联QRS波呈宽M型的LBBB患者中左心室心肌运动不同步的发生率较高。
OBJECTIVE: To analyze left ventricular synchrony in patients with broad M-type left bundle branch block (LBBB) by I-guided surface electrocardiography using tissue Doppler and real-time three-dimensional echocardiography. Methods: 46 patients with LBBB were divided into LBBBM type group (20 cases) and LBBB non-M type group (26 cases) according to whether QRS wave of I lead of body surface ECG was wide M type, and 40 cases of normal control group were selected. Tissue Doppler technique was used to determine the peak time of systole (TS) in 12 segments of left ventricular myocardium in both groups, and the peak time difference (TS) was calculated. The cardiac synchrony was evaluated by TSS> 65ms. The left ventricular end-diastolic volume, end-systolic volume, and left ventricular ejection fraction were measured by real-time three-dimensional ultrasound. Qlab quantitative analysis software was used to quantitatively analyze the 3D real-time three-dimensional images of all the patients. , 17 segment volume curve, 17 segment Vmax and its standard deviation (Vmax-SD), the average minimum volume (Vmin) and its standard deviation (Vmin-SD), the minimum volume point distance ECG Q wave The mean time of onset (T) and its standard deviation (T-SD), the minimum volume point of the 17 segments, the maximum time difference (Tmax) from the Q-wave onset of the electrocardiogram. Results: ① The TSS> 65 ms between different segments in the same myocardial wall was used as the asynchronous standard of myocardial contraction. The incidence of left ventricular nonsynchronization in patients with LBBBM was 85.00% (17/20), which was significantly higher 57.69% (15/26) in LBBB non-M type, P <0.05; (2) There was significant difference in Vmin-SD, T-SD and Tmax between LBBBM group and LBBB non-M group (P <0.05-0.01) . Conclusion: Tissue Doppler echocardiography and real-time three-dimensional echocardiography confirmed that there was a high incidence of left ventricular myocardial asynchrony in patients with LBBB with wide M-shaped QRS waves of surface ECG.