CAJ | 학술논문

目的应用心肌造影超声心动图(MCE)定量评价心脏再同步化治疗(CRT)后心肌血流量的变化,以研究CRT是否能够改善心肌灌注.方法将12条比格犬随机分为A、B两组,分别结扎第一对角支,建立心肌梗死后心力衰竭的动物模型.随后A组植入三腔起搏器,行心脏再同步化治疗；B组亦植入三腔起搏器,但不启动起搏器.在基础状态、起搏器术前及起搏器术后4周,用MCE和斑点追踪显像技术定量评价心肌血流量(MBF值),环向、径向和纵向12节段达峰时间标准差(Cir12SD、R12SD和L12SD),探讨CRT对心肌灌注水平的影响.结果基础状态及CRT术前,A、B两组的左室射血分数(LVEF)、左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、Cir1 2SD和R12SD均无明显差异(P＞0.05).CRT后4周,A、B两组的LVEF、LVEDV、LVESV、Cir12SD和R12SD分别为(58.8±8.2)％对(39.5±8.7)％,(28.2±2.9) ml对(34.2±2.5) ml,(13.9±2.6) ml对(21.5±4.7) ml,(29.1±6.6)ms对(46.5±10.1)ms和(36.1±10.7)ms对(67.6±11.2)ms(P均＜0.05).基础状态下A、B两组的A、β和MBF值分别为(13.6±2.2)dB对(14.9±3.0)dB,(5.1±1.1)s-1对(4.8± 2.1)s-1,(67.6±12.1)dB/s对(72.8±8.6)dB/s(P＞0.05).在CRT术前A组和B组的A、β和MBF值分别为(7.4±1.2)dB对(7.3±2.7)dB,(3.9±0.9)s-1对(2.9±0.9)s-1,(23.4±4.2)dB/s对(22.2±4.1)dB/s(P均＞0.05).在CRT术后4周A组的A、β和MBF值较B组显著提高,分别为(12.1±1.8)dB对(9.5±1.7)dB,(4.7±0,3)s-对(3.1±0.8)s-1,(47.2±8.6)dB/s对(29.5±4.2)dB/s(P均＜0.05).结论心肌梗死后心力衰竭犬行心脏再同步化治疗,不仅能改善心脏收缩同步性,更能改善缺血心肌的心肌灌注.
목적 응용심기조영초성심동도(MCE)정량평개심장재동보화치료(CRT)후심기혈류량적변화,이연구CRT시부능구개선심기관주.방법 장12조비격견수궤분위A、B량조,분별결찰제일대각지,건립심기경사후심력쇠갈적동물모형.수후A조식입삼강기박기,행심장재동보화치료；B조역식입삼강기박기,단불계동기박기.재기출상태、기박기술전급기박기술후4주,용MCE화반점추종현상기술정량평개심기혈류량(MBF치),배향、경향화종향12절단체봉시간표준차(Cir12SD、R12SD화L12SD),탐토CRT대심기관주수평적영향.결과 기출상태급CRT술전,A、B량조적좌실사혈분수(LVEF)、좌실서장말용적(LVEDV)、좌실수축말용적(LVESV)、Cir1 2SD화R12SD균무명현차이(P＞0.05).CRT후4주,A、B량조적LVEF、LVEDV、LVESV、Cir12SD화R12SD분별위(58.8±8.2)％대(39.5±8.7)％,(28.2±2.9) ml대(34.2±2.5) ml,(13.9±2.6) ml대(21.5±4.7) ml,(29.1±6.6)ms대(46.5±10.1)ms화(36.1±10.7)ms대(67.6±11.2)ms(P균＜0.05).기출상태하A、B량조적A、β화MBF치분별위(13.6±2.2)dB대(14.9±3.0)dB,(5.1±1.1)s-1대(4.8± 2.1)s-1,(67.6±12.1)dB/s대(72.8±8.6)dB/s(P＞0.05).재CRT술전A조화B조적A、β화MBF치분별위(7.4±1.2)dB대(7.3±2.7)dB,(3.9±0.9)s-1대(2.9±0.9)s-1,(23.4±4.2)dB/s대(22.2±4.1)dB/s(P균＞0.05).재CRT술후4주A조적A、β화MBF치교B조현저제고,분별위(12.1±1.8)dB대(9.5±1.7)dB,(4.7±0,3)s-대(3.1±0.8)s-1,(47.2±8.6)dB/s대(29.5±4.2)dB/s(P균＜0.05).결론 심기경사후심력쇠갈견행심장재동보화치료,불부능개선심장수축동보성,경능개선결혈심기적심기관주.
Objective To investigate the impact of myocardial contrast echocardiography (MCE) on evaluating the myocardial perfusion in beagles with ischemic cardiomyopathy and cardiac resynchronization therapy (CRT),and to estimate the myocardial perfusion by myocardial blood flow (MBF) value.Methods Twelve adult beagles were randomly divided into two groups (CRT group and non-CRT group).Each beagle underwent a ligature in the first diagonal branch and a pacemaker was implanted.The pacing was started in CRT group,but was not started in non-CRT group.MCE and speckle tracking imaging were performed to evaluate the MBF value and circumferential strain (Cir1 2SD),radial strain (R12SD) and longitudinal strain (L12SD) of 12 segments of left ventricle at baseline,before CRT,and 4 weeks after CRT.Results There was no significant difference of LVEF,LVEDV,LVESV,Cir12SD,and R12SD between two groups at baseline or before CRT( P ＞0.05).After 4 weeks of CRT,LVEF,LVEDV,LVESV,Cir1 2SD,and R 12SD in two groups were ( 58.8 ± 8.2 ) ％ vs (39.5 ± 8.7 ) ％,(28.2 ± 2.9) ml vs (34.2 ± 2.5 ) ml,( 13.9± 2.6 ) ml vs (21.5± 4.7)ml,(29.1 ± 6.6)ms vs (46.5 ± 10.1)ms and (36.1 ± 10.7)ms vs (67.6± 11.2)ms( P ＜0.05 ).A,β,and MBF value between two groups were ( 13.6 ± 2.2 )dB vs ( 14.9 ± 3.0)dB,(5.1±1.1 )s- 1 vs (4.8 ± 2.1 )s- 1,(67.6 ± 12.1)dB/s vs (72.8 ± 8.6)dB/s( P ＞0.05) at baseline and were (7.4 ± 1.2)dB vs (7.3±2.7)dB,(3.9±0.9)s-1 vs (2.9±0.9)s-1,(23.4±4.2)dB/s vs (22.2±4.1)dB/s (P＞0.05)before CRT.After 4 weeks of CRT,A,β,and MBF value in CRT group were higher than those in non-CRT group (12.1 ± 1.8)dB vs (9.5 ± 1.7)dB,(4.7 ± 0.3)s-1 vs (3.1 ± 0.8)s-1,(47.2 ± 8.6)dB/s vs (29.5 ±4.2)dB/s,all P ＜0.05).Conclusions In beagles with ischemic cardiomyopathy,CRT can not only improve cardiac synchrony,but also increase myocardial perfusion.