二维斑点追踪超声心动图评价孤立性心房颤动患者左心房功能、运动同步性及预测消融术后复发的价值

发布时间：2018-10-15 16:25

【摘要】：目的:应用二维斑点追踪超声心动图(2D-STE)评价孤立性心房颤动(房颤)患者的左心房功能及运动同步性,并探讨2D-STE参数在预测房颤消融术后复发中的价值。方法:纳入2013-06至2015-05期间诊断为孤立性房颤患者50例,为孤立性房颤组,另选我院的健康体检者35例作为健康对照组。孤立性房颤组中,有34例患者的左心房无扩大为左心房无扩大亚组,另外16例为左心房扩大亚组。在窦性心律的条件下,应用2D-STE技术,获得左心房长轴整体及各个节段的应变及应变率曲线。测量左心房在心室收缩期峰值应变(PALS)及应变率(SRs)和舒张晚期峰值应变(ACLS)及应变率(SRa),并测量各个节段达峰值应变时间,并计算各个节段的达峰时间标准差(TPSD)。心室收缩期的TPSD,命名为SDs,舒张晚期的TPSD,命名为SDa。结果:孤立性房颤组的PALS(28.34±8.57 vs 38.73±6.13)、SRs(1.17±0.31 vs 1.57±0.25)、ACLS(14.11±4.91vs 18.86±3.57)、SRa(-1.41±0.58 vs-1.90±0.30)均较健康对照组明显降低(P均0.05),SDs[(8.11±3.00)%vs(4.67±1.48)%]、SDa[(5.57±2.26)%vs(3.11±1.13)%]均较健康对照组明显增大(P均0.05)。另外,孤立性房颤组中的左心房无扩大亚组的PAL、SRs、ACLS、SRa低于健康对照组(P均0.05),SDs,SDa大于健康对照组(P均0.05)。Logistic回归分析结果显示SDs,SDa能够较传统参数更有效的区分孤立性房颤和对照组(SDs:敏感度83%,特异度72%;SDa:敏感度81%,特异度76%)。SDs,SDa的增大是预测孤立性房颤消融术后复发的最佳因素(SDs:敏感度80%,特异度71%;SDa:敏感度86%,特异度79%)。结论:2D-STE技术能够检测出孤立性房颤患者的左心房功能降低和运动不同步,左心房无扩大的孤立性房颤患者,2D-STE参数仍有显著异常。SDs、SDa能够较传统参数更有效的区分孤立性房颤和健康者,而且是预测房颤术后复发的最佳因素。
[Abstract]:Objective: to evaluate left atrial function and motor synchronism in patients with isolated atrial fibrillation (AF) by two dimensional speckle tracing echocardiography (2D-STE) and to explore the value of 2D-STE parameters in predicting recurrence after AF ablation. Methods: a total of 50 patients with isolated atrial fibrillation were selected from 2013-06 to 2015-05 as the isolated atrial fibrillation group, and 35 healthy persons in our hospital were selected as the healthy control group. In the isolated atrial fibrillation group, 34 patients had left atrium without enlargement as left atrial expansion subgroup, and 16 patients had left atrial enlargement subgroup. Under the condition of sinus rhythm, the strain and strain rate curves of the whole and each segment of the left atrial long axis were obtained by 2D-STE technique. The peak strain (PALS) and strain rate (SRs) and late diastolic peak strain (ACLS) and strain rate (SRa), of left atrium were measured and the peak strain time of each segment was measured, and the standard deviation (TPSD). Of peak time of each segment was calculated. Ventricular systolic TPSD, is named SDs, late diastolic TPSD, named SDa. Results: the PALS of isolated atrial fibrillation group (28.34 卤8.57 vs 38.73 卤6.13), SRs (1.17 卤0.31 vs 1.57 卤0.25), ACLS (14.11 卤4.91vs 18.86 卤3.57), SRa (-1.41 卤0.58 vs-1.90 卤0.30) was significantly lower than that of the healthy control group (P 0.05) (P 0.05), SDs [(8.11 卤3.00)% vs (4.67 卤1.48)%], SDa [(5.57 卤2.26)% vs (3.11 卤1.13)%] was significantly higher than that of the healthy control group (P 0.05). In addition, In the isolated atrial fibrillation group, the PAL,SRs,ACLS,SRa of the left atrium without enlargement subgroup was lower than that of the healthy control group (all P 0.05), and the SDs,SDa of the left atrial fibrillation group was higher than that of the healthy control group (P 0.05). Logistic regression analysis showed that SDs,SDa could distinguish the isolated atrial fibrillation from the control group more effectively than the traditional parameters). The increase of SDs,SDa is the best factor to predict the recurrence of isolated atrial fibrillation (SDs: sensitivity 80%, specificity 71%: sensitivity 86%, specificity 79%). Conclusion: 2D-STE technique can detect decreased left atrial function and abnormal motion in patients with isolated atrial fibrillation. In patients with left atrial fibrillation without enlargement, 2D-STE parameters were still significantly abnormal. SDs,SDa was more effective than traditional parameters in distinguishing isolated atrial fibrillation from healthy subjects, and was the best predictor of postoperative recurrence of atrial fibrillation.
【作者单位】：大连医科大学附属第一医院心内科;大连医科大学附属第二医院重症监护病房;中国医科大学附属第一医院心血管超声科;
【分类号】：R541.75

【相似文献】