超声在CRT植入后程控随访的应用.ppt

每搏输出量＝左室流出道面积×速度时间积分（VTI）左室流出道面积固定，VTI越大，每搏输出量就越大 25 mm/sec  100 mm/sec 50 mm/sec 扫描速度  Aortic VTI guided V-V Optimization-Assessment of Stroke VolumeUsed in Insync III Pacemaker Study Stroke Volume by VTI The volume of blood ejected by the LV each beat = Stroke Volume Stroke Volume= LVOT area X Velocity Time Integral (VTI) Since LVOT is a constant the larger VTI the larger stroke volume DLVOT Time (sec) VTI (cm) = Area under velocity curve/time Velocity cm/sec VTI is DEPENDENT on the Echo Tech’s Skills 不正确 正确 Get Parallel to FlowUse Your Road Map Optimizing VV Delay Based on Aortic VTI- Echo Tech Duties Obtain Pulsed Wave Doppler of LVOT with several different sequential ventricular paced intervals Select the setting yielding the largest VTI as the optimal paced interval LV 40 22.67 每个程控的V-V 设置时，左室流出道的VTI 形迹。 Optimizing VV Delay Based on Aortic VTI LV first by 4 ms LV first by 20 ms RV first by 40 ms 优化后 优化前 Where V-V timing parameters are selected- Rep Duties VTI Assessment REP: Obtain LV threshold REP: Ensure absence of anodal stimulation if pacing LV tip/RV ring ECHO TECH: Measure VTI at various V-V pace delays ECHO TECH: Confirm acceptable E and A wave separation, and completion of the A-waves at the V-V setting which produces the greatest VTI REP: Program V-V delay 18.27 20.71 18.9 18.9 Echo Tech measures area under curve and determines which V-V delay gives the greatest VTI Best VTI 22.67 CARE-HF研究入选标准 1，＞18岁，心衰至少6周，尽管标准药物治疗但NYHAIII/IV 2, EF≤35%，LEVD≥30mm/m(indexed to height) (注:一般要求LEVD＞55mm,但不同患者体型不同，这里要通过除以身高参数重新换算） 3，QRS ≥120ms 如果QRS在120ms和149ms之间，则需要满足以下3项条件的两项 a, 主动脉射血前延迟＞140ms b,心室间机械延迟＞40ms c,左室后外侧壁激动延迟 （用M型或组织超声测定跨二尖瓣多普勒血流信号，指左室充盈开始后左室后外侧壁最大收缩） 主动脉射血前间期和左右心室间机械延迟 主动脉射血前间期Aortic Pre-ejection interval (APEI) 由心电图上 Q波到主动脉瓣开放的这段时间 (Figure at right) 正常值 = 93±14 ms1 不同步者 = ?; 有LBBB时133 ±30 ms,1 140 ms proposed2 左右心室间机械延迟 (IVMD) IVMD = APEI 减去心电图上Q波到肺动脉瓣开放的时间 (figure below r