实时三维经食管超声心动图评价房颤患者左心耳形态、机械功能及峰值速度的研究

发布时间：2019-04-21 18:05

【摘要】：背景心房颤动(以下简称为房颤)是临床最常见的心律失常之一,其男性发病率稍高于女性,且随着年龄的增长其发病率增高。房颤持续时间达48小时即可以发生左心房内的附壁血栓形成,而左心耳是其最常见的附壁血栓形成部位。90%的非瓣膜病性房颤和57%的瓣膜病性房颤患者血栓位于左心耳。因此,准确评估房颤患者左心耳的形态、机械功能及峰值速度对房颤患者治疗方法和手术时机的选择及预后评估起着非常重要的作用。经食管三维超声历经静态、动态、实时3个阶段的发展,目前实时三维经食管超声心动图能够精准、清晰地显示左心耳的动态、立体解剖结构,更为准确地提供左心耳的大小、功能指标等参数,为临床评价左心耳的形态、机械功能及峰值速度提供准确、可靠的信息。目的探讨应用实时三维经食管超声心动图评价房颤患者左心耳形态及功能的可行性;评价房颤患者左心耳机械功能与峰值速度的变化及两者之间的相关性。方法51例房颤患者及38例窦性心律患者行实时三维经食管超声心动图检查,在0°~180°范围内显示左心耳二维结构,于45°左心耳长轴切面,存储左心耳二维结构图像,测量其开口内径及深度。点击XPlane,通过调节两个互相垂直的二维图像,确保取样框将左心耳完整包络覆盖后,启动3D ZOOM模式采集左心耳的三维结构图像。应用脉冲多普勒在距左心耳开口1cm处探测并采集左心耳的血流频谱,测量左心耳的最大排空速度(即峰值速度)。检查过程中连接胸导联心电图,使得图像与心电图同步显示。房颤患者连续记录5个心动周期,窦性心律患者连续记录3个心动周期。完成图像采集后,将图像存储至硬盘用以脱机分析。对左心耳的三维图像自由切割显示其分叶数目;分别应用二维面积法、三维面积法及三维容积法测量左心耳的排空分数,并采用单因素方差分析比较其有无统计学差异;房颤组与窦性心律组左心耳排空分数及峰值速度的比较采用独立样本t检验;应用脉冲多普勒测量左心耳的峰值速度,采用Pearson相关分析左心耳排空分数与峰值速度的相关性,测量的变异性采用Bland-Altman一致性分析,P0.05为差异有统计学意义。结果89例患者中左心耳为单叶9例,2叶48例,3叶24例,4叶8例;二维面积法、三维面积法及三维容积法所测得左心耳排空分数间比较均无统计学差异(P0.05);房颤组较窦性心律组左心耳排空分数及峰值速度均减低,差异有统计学意义(FEFA-2D=4.374,P=0.000;FEFA-3D=6.440,P=0.001;FEFV-3D=52.469,P=0.004;FPEV=1.640,P=0.004);89例患者左心耳排空分数与峰值速度均呈正相关(rEFA-2D=0.504,P=0.000;rEFA-3D=0.631,P=0.000;rEFV-3D=0.644,P=0.000);随机抽取43例行Bland-Altman一致性分析,二维面积法、三维面积法及三维容积法测得左心耳排空分数和脉冲多普勒测得左心耳的峰值速度在观察者之间和观察者内部均具有较好的一致性。结论1、不同个体间左心耳形态各异,实时三维经食管超声心动图能够清晰显示左心耳的分叶数目,测量其开口内径及深度;2、实时三维经食管超声心动图可定量评价左心耳机械功能;3、房颤患者左心耳的机械功能较窦性心律患者降低,即排空分数及峰值速度降低;4、左心耳的峰值速度可间接反映其收缩功能。
[Abstract]:Background Atrial fibrillation (hereinafter referred to as atrial fibrillation) is one of the most common types of arrhythmias in the clinic, with a slightly higher incidence of men and an increase in incidence with age. The duration of atrial fibrillation is up to 48 hours, i.e., mural thrombus in the left atrium can occur, and the left atrial appendage is the most common mural thrombus formation site in the left atrium.90% of non-valvular atrial fibrillation and 57% of the patients with valvular heart disease are located in the left atrial appendage. Therefore, it is very important to accurately assess the shape, mechanical function and peak speed of the left atrial appendage in patients with atrial fibrillation. The three-dimensional transesophageal echocardiography has undergone the development of static, dynamic and real-time three stages, and the real-time three-dimensional transesophageal echocardiography can accurately and clearly display the dynamic and three-dimensional anatomical structure of the left atrial appendage, and more accurately provides parameters such as the size of the left atrial appendage, the function index and the like, To provide accurate and reliable information for the clinical evaluation of the shape, mechanical function and peak speed of the left atrial appendage. Objective To study the feasibility of using real-time three-dimensional transesophageal echocardiography to evaluate the shape and function of left atrial appendage in patients with atrial fibrillation, and to evaluate the relationship between the changes of the mechanical function and the peak velocity of the left atrial appendage in patients with atrial fibrillation. Methods A real-time three-dimensional transesophageal echocardiography was performed in 51 patients with atrial fibrillation and 38 patients with atrial fibrillation. The two-dimensional structure of the left atrial appendage was displayed in the range of 0 掳 to 180 掳, and the two-dimensional structure image of the left atrial appendage was stored in the long axis of the left atrial appendage at 45 掳, and the inner diameter and depth of the opening were measured. Click XPlane to ensure that the three-dimensional structural image of the left atrial appendage is acquired by adjusting the two two-dimensional images that are perpendicular to each other, and ensuring that the sampling frame covers the full envelope of the left atrial appendage. The pulse Doppler was applied to detect and collect the blood flow spectrum of the left atrial appendage at 1 cm from the left atrial appendage opening and measure the maximum emptying rate of the LAA (i.e., the peak velocity). The electrocardiogram of the chest lead is connected in the course of the inspection so that the image is displayed synchronously with the electrocardiogram. The patients with atrial fibrillation recorded a continuous recording of 5 cardiac cycles, and the patients with atrial fibrillation recorded a continuous recording of 3 cardiac cycles. After the image acquisition is complete, the image is stored to the hard disk for offline analysis. the three-dimensional image of the left atrial appendage is free to cut and display the number of the leaves of the left atrial appendage; the two-dimensional area method, the three-dimensional area method and the three-dimensional volume method are respectively applied to measure the emptying score of the left atrial appendage, and the statistical difference is compared by a single-factor analysis of variance; The left atrial appendage emptying score and the peak velocity of the atrial fibrillation group were compared with the peak velocity. The peak velocity of the left atrial appendage was measured by pulse Doppler, and the correlation between the left atrial appendage emptying score and the peak velocity was analyzed with Pearson correlation. The variability of the measured variability was analyzed by the Band-Altman analysis, and the difference was significant between P0.05. Results The left atrial appendage in 89 patients was 9,48,3 and 4, respectively. The two-dimensional area method, three-dimensional area method and three-dimensional volume method had no statistical difference between the left atrial appendage and the left atrial appendage (P0.05). The left atrial appendage emptying score and the peak velocity of the atrial fibrillation group were lower than that of the left atrial appendage (FEFA-2D = 4.374, P = 0.000; FEFA-3D = 6.440, P = 0.001; FEV-3D = 52.469, P = 0.004; FPEV = 1.640, P = 0.004); the left atrial appendage emptying score of 89 patients was positively correlated with the peak velocity (rEFA-2D = 0.504, P = 0.000; rEFA-3D = 0.631, P = 0.000; rEFV-3D = 0.644, P = 0.000); The left atrial appendage (LAA) and the left atrial appendage (LAA) have a good agreement between the observer and the observer, with the left atrial appendage emptying score and the pulse Doppler measured by the method of the random extraction of 43 cases of BLand-Altman analysis, two-dimensional area method, three-dimensional area method and three-dimensional volume method. Conclusion 1. The left atrial appendage is different in different individuals. The real-time three-dimensional transesophageal echocardiography can clearly show the number of the left atrial appendage and measure the inner diameter and depth of the left atrial appendage;2. The real-time three-dimensional transesophageal echocardiography can quantitatively evaluate the mechanical function of the left atrial appendage; and 3, The mechanical function of the left atrial appendage in the patients with atrial fibrillation is lower, that is, the evacuation score and the peak velocity are reduced; and 4, the peak velocity of the left atrial appendage can indirectly reflect its systolic function.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75;R540.45

【相似文献】