不同消融术式对房颤患者左心房重构的影响：2D-STI和RT-3DE研究

发布时间：2018-06-29 12:09

本文选题：心房颤动 + 左心房重构　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的采用二维斑点追踪成像技术(2D-STI)和实时三维超声心动图(RT-3DE)评价不同消融术式对房颤患者左心房重构的影响。方法将49例阵发性房颤患者根据消融术式不同分为两组:射频消融组(RFA)30例,冷冻球囊消融组(CBA)19例。于术前、术后3天、术后1月,应用常规超声心动图测量左房内径;应用2D-STI检测收缩期、舒张早期、舒张晚期左房壁峰值应变(Ss、Se、Sa)、应变率(SRs、SRe、SRa)及左房整体应变(m Ss、m Se、m Sa)、应变率(m SRs、m SRe、m SRa);测量左房各节段电-机械传导时间(EMT),并计算左房平均电-机械传导时间(m EMT)及各节段电-机械传导时间标准差(EMT-SD)。应用RT-3DE测量左房各时相容积,计算左房最大容积指数(LAVImax)、左房最小容积指数(LAVImin)、左房总射血分数(LATEF)、左房被动射血分数(LAPEF)、左房主动射血分数(LAAEF)。结果(1)RFA组与CBA组比较,术前、术后3天、术后1月LAD、LAVImax、LAVImin、LATEF、LAAEF、LAPEF差异均无统计学意义(P0.05);术前、术后1月,两组间左房各壁及整体应变、应变率差异无统计学意义(P0.05);术后3天,CBA组左房各壁Sa、SRa及m Sa、m SRa较RFA组减小(P0.05)。(2)与术前比较,RFA组术后3天LAD、LAVImax、LAVImin增大(P0.05),LAAEF、左房各壁及整体应变、应变率减小(P0.05),左房m EMT、EMT-SD增大(P0.05);术后1月LAD、LAVImax、LAVImin减小(P0.05),左房后壁应变及应变率减小(P0.05),左房m EMT缩短(P0.05)。与术后3天比较,RFA组术后1月LAD、LAVImax、LAVImin减小(P0.05),LATEF、LAAEF、LAPEF增大(P0.05),左房侧壁、间隔壁、前壁、下壁及整体应变、应变率增大(P0.05),左房m EMT、EMT-SD减小(P0.05)。(3)与术前比较,CBA组术后3天LAVImin增大(P0.05),LATEF、LAAEF减小(P0.05),左房各壁及整体应变、应变率减低(P0.05),且后壁Ss、Sa、SRs、SRa显著减低(P0.01),左房m EMT、EMT-SD增大(P0.05);术后1月LAD、LAVImax、LAVImin减小(P0.05),左房后壁Ss、Sa、SRs、SRa减低(P0.05),左房m EMT缩短(P0.05)。与术后3天比较,CBA组术后1月LAD、LAVImax、LAVImin、减小(P0.05),LATEF、LAAEF、LAPEF增大(P0.05),左房各壁及整体应变、应变率增大(P0.05),左房m EMT、EMT-SD减低(P0.05)。结论(1)RFA和CBA两种消融术式对房颤患者左房结构、功能、电重构的影响在术后1月无明显差异。(2)RFA组和CBA组术后3天均出现左房顿抑,导致左房增大,左房存储功能、管道功能、辅助泵功能降低;术后3天,CBA组左房辅助泵功能较RFA组降低更明显。(3)消融术后1月,RFA组和CBA组左房结构重构及电重构均发生逆转,但左房功能重构与术前比较未见明显改善,且左房后壁应变、应变率较术前减低。
[Abstract]:Objective to evaluate the effects of different ablation methods on left atrial remodeling in patients with atrial fibrillation by two dimensional speckle tracing imaging (2D-STI) and real-time three-dimensional echocardiography (RT-3DE). Methods 49 patients with paroxysmal atrial fibrillation were divided into two groups: radiofrequency ablation (RFA) group (30 cases) and cryopreservation balloon ablation group (CBA) (19 cases). The left atrial diameter was measured by routine echocardiography before operation, 3 days after operation, 1 month after operation, 2D-STI was used to detect systolic phase and early diastolic phase. Peak strain of left atrial wall in late diastolic stage (SsSe Se Sa), strain rate (SRS), global strain of left atrium (m Ssm Sem sa), strain rate (m SRsm SRem SRa), electromechanical conduction time (EMT) of each segment of left atrium were measured, and mean electromechanical conduction time (mEMT) of left atrium was calculated and the mean electromechanical conduction time (mEMT) of left atrium was calculated by measuring the mean electromechanical conduction time (mEMT) of left atrium and calculating the mean electromechanical conduction time (mEMT) of left atrium. Standard deviation of conduction time (EMT-SD). The left atrial maximum volume index (LAVImax), left atrial minimum volume index (LAVImin), left atrial total ejection fraction (LATEF), left atrial passive ejection fraction (LAPEF) and left atrial active ejection fraction (LAAEF) were measured by RT-3DE. Results (1) there was no significant difference in LAPEF between RFA group and CBA group before operation, 3 days after operation and 1 month after operation (P0.05). There was no significant difference in strain rate (P0.05), SAA SRa and m SaomSRa in left atrial wall decreased in CBA group 3 days after operation (P0.05). (2) and LAVImax LAVImin increased 3 days after operation (P0.05), left atrial wall and global strain increased. Strain rate decreased (P0.05), left atrial mEMTT EMT-SD increased (P0.05), LAVImaxl LAVImin decreased (P0.05), left atrial posterior wall strain and strain rate decreased (P0.05), left atrial mEMT shortened (P0.05). Compared with 3 days after operation, LAVImaxand LAVImin decreased in RFA group (P0.05). LATEFN LAAEFF LAPEF increased (P0.05), left atrial lateral wall, adnexal wall, anterior wall, inferior wall and global strain. The strain rate increased (P0.05), the left atrial m EMTN EMT-SD decreased (P0.05). (3), the LAVImin increased 3 days after operation (P0.05), the LAAEF decreased (P0.05), the left atrial wall and global strain decreased. The strain rate was decreased (P0.05), and the SRA in the posterior wall was significantly decreased (P0.01), and the left atrial mEMT-EMT-SD was increased (P0.05), but LAVImaxLAVImin was decreased (P0.05), the Sssfen SaSSASRssSMA SRA was decreased (P0.05), and the left atrial mEMT was shortened (P0.05) in the posterior wall of left atrium. Compared with 3 days after operation, LAVImaxlavimin decreased (P0.05), left atrial wall strain and overall strain increased (P0.05), left atrial mEMT-EMT-SD decreased (P0.05) in CBA group. Conclusion (1) the effects of RFA and CBA on left atrial structure, function and electrical remodeling in patients with atrial fibrillation were not significantly different at one month after operation. (2) left atrial arrest occurred in RFA group and CBA group 3 days after operation, resulting in left atrial enlargement, left atrial storage function and conduit function. The left atrial auxiliary pump function in CBA group was significantly lower than that in RFA group 3 days after operation. (3) the left atrial structure remodeling and electrical remodeling were reversed in RFA group and CBA group at 1 month after ablation, but left atrial function remodeling was not significantly improved compared with that before operation. The strain and strain rate of the posterior wall of left atrium were lower than those before operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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