| Purpose:At present,biventricular pacing-based cardiac resynchronization therapy(BVP-CRT)has achieved definite efficacy in patients with chronic heart failure(CHF)combining left bundle branch block(LBBB),however,there are still some patients because they are non-true LBBB,left ventricular electrode implantation position is not the most delayed position of myocardial contraction,which may cause CRT is unresponsive,and BVP activation is nonphysiological.Recently,with left bundle branch pacing(LBBP)developing,in theory,pacing below the block site preserves the left ventricular physiologic activation sequence,but the difference which the most delayed position of myocardial movement for different types of LBBB is not yet clear.The purpose of this study is to use Ultrasonic cardiogram(UCG)technology to explore the differences among the atrioventricular,interventricular,left ventricular synchronization and the distribution of the most delayed myocardial segment in CHF patients with different types of LBBB,used for guiding the selection of the most suitable anti-heart failure pacing method for patients with different LBBB types.Method:A total of twenty-five CHF patients who were admitted to the Department of Cardiology of the First Affiliated Hospital of Kunming Medical University from January to December 2019 and met LBBB electrocardiogram were included in the case group.According to the QRS wave shape of the electrocardiogram,the true LBBB(t-LBBB)group(n=12)met the diagnostic criteria proposed by Strauss.the false-LBBB(f-LBBB)group(n=13)conformed the traditional LBBB diagnostic criteria,have not yet reached the Strauss diagnostic criteria,in addition,thirteen patients whose the ECG performance is normal,echocardiogram confirmed non-organic heart disease were used as the control group.Using real-time three-plane tissue synchronized imaging(RT3PE-TSI)technology was to measure the twelve-segment contraction time to peak(TTP)and obtained "cow Eye diagram",measure the index of left ventricular synchronization:standard deviation of twelve segments peak time(12-Tp-SD),maximal deviation of twelve segments peak time(12-Tp-maxD),pulse wave doppler(PWD)was used for measuring atrioventricular synchronization index:left ventricular diastolic filling time rate(LVDFT/RR),interventricular synchronization index:Interventricular mechanical delay time(IVMD),comparing three groups of atrioventricular,interventricular and left ventricular myocardial motion synchronization index and the distribution of delayed segments.The SPSS25.0 statistical software was used to analyze the data,and the difference was statistically significant while P<0.05.Result:1.The LVEF(33.67±7.27)of t-LBBB group and the LVEF(34.38±8.67)of f-LBBB group were smaller than the control group(73.85±5.01,P<0.01),the LVEDD(65.92±6.87)of t-LBBB group and f-LBBB group(68.54±9.40)were larger than the control group(43.00±5.18,P<0.01),the LVDFT/RR(38.50±5.16)of t-LBBB group,and the LVDFT/RR(46.31±4.42)of f-LBBB group were less than the control group(56.92±7.76,P<0.01),the IVMD of the t-LBBB group(67.94±25.49)and the IVMD of the f-LBBB group(46.29+23.52)were larger than the control group(13.00±8.26,P<0.01),the 12-Tp-SD,12-Tp-maxD of t-LBBB group(136.52±38.63,369.75±87.91)and the 12-Tp-SD,12-Tp-maxD of f-LBBB group(142.77±29.59,376.54±57.19)were larger than the control group(18.61±7.50,59.92±26.14,P<0.01),t-LBBB group compared with f-LBBB group:LVDFT/RR(38.50±5.16 VS.46.31±4.42,P=0.002),IVMD(67.94±25.49 VS.46.29±23.52,P=0.012)had a statistical difference(P<0.05),LVEF,LVEDD,12-Tp-SD and 12-Tp-maxD had no statistical difference(P>0.05).2.Comparison of the distribution of mild and moderate to severe delayed segments in the left ventricular between the t-LBBB group and the f-LBBB group:the mild delayed segments on the lateral wall[t-LBBB group 0(0.0%)VS.f-LBBB Group 11(42.3%),P=0.000],the posterior wall[t-LBBB group 4(16.7%)VS.f-LBBB group 14(53.8%),P=0.006]had a statistically significant difference(P<0.05),the moderate to severe delayed segments on the posterior interval[(t-LBBB group 7(29.2%)VS.f-LBBB group 17(65.4%),P=0.010],lateral wall[t-LBBB group 15(62.5%)VS.f-LBBB group 1(3.8%),P=0.000],anterior interval[t-LBBB group 3(12.5%)VS.f-LBBB group 16(61.5%),P=0.000],posterior wall[T-LBBB group 19(79.2%)VS.f-LBBB group 5(19.2%),P=0.000]had a statistically significant difference(P<0.05),the mild delayed segments of f-LBBB group were significantly more than t-LBBB group on the lateral and posterior wall,the moderate to severe delayed segments of f-LBBB group were significantly more than t-LBBB group on the anterior and posterior interval,the moderate to severe delayed segments of t-LBBB group were significantly more than f-LBBB group on the lateral and posterior wall.The mild delayed segments of two groups on the posterior interval,anterior wall,inferior wall,and anterior interval had no statistical difference(P>0.05).the moderate to severe delayed segments of two groups on the anterior wall,inferior wall had no statistical difference(P>0.05).3.Comparison of the distribution of most delayed segments in the left ventricular between the t-LBBB group and the f-LBBB group:the distribution of the posterior wall[t-LBBB group 7(58.3%)VS.f-LBBB Group 1(7.7%),P=0.030],and interval wall[t-LBBB group 0(0.0%)VS.f-LBBB Group 7(53.8%),P=0.005]had a statistically significant difference(P<0.05),The most delayed segments in the t-LBBB group were mostly distributed in the posterior wall[7(58.3%)]and lateral wall[3(25.0%)].The most delayed segments in the f-LBBB group were mostly distributed in the interval wall[7(53.8%)],the inferior wall[5(38.5%)].Conclusion:1.The atrioventricular and interventricular synchronization of t-LBBB patients are worse than that of f-LBBB patients,and the left interiorventricular synchronization has no significant difference between the two groups.2.RT3PE-TSI technique can be used for evaluating the most delayed position of left ventricular myocardial movement in CHF patients with different types of LBBB,the most delayed position of t-LBBB is mainly distributed on the posterior wall and lateral wall,the most delayed position of f-LBBB is mainly distributed on the interval wall,suggesting the selection of LBBP may be better than BVP-CRT. |
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