【摘要】：目的:應(yīng)用二維斑點追蹤超聲心動圖(2D-STE)評價孤立性心房顫動(房顫)患者的左心房功能及運動同步性,并探討2D-STE參數(shù)在預(yù)測房顫消融術(shù)后復(fù)發(fā)中的價值。方法:納入2013-06至2015-05期間診斷為孤立性房顫患者50例,為孤立性房顫組,另選我院的健康體檢者35例作為健康對照組。孤立性房顫組中,有34例患者的左心房無擴大為左心房無擴大亞組,另外16例為左心房擴大亞組。在竇性心律的條件下,應(yīng)用2D-STE技術(shù),獲得左心房長軸整體及各個節(jié)段的應(yīng)變及應(yīng)變率曲線。測量左心房在心室收縮期峰值應(yīng)變(PALS)及應(yīng)變率(SRs)和舒張晚期峰值應(yīng)變(ACLS)及應(yīng)變率(SRa),并測量各個節(jié)段達峰值應(yīng)變時間,并計算各個節(jié)段的達峰時間標(biāo)準(zhǔn)差(TPSD)。心室收縮期的TPSD,命名為SDs,舒張晚期的TPSD,命名為SDa。結(jié)果:孤立性房顫組的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)均較健康對照組明顯降低(P均0.05),SDs[(8.11±3.00)%vs(4.67±1.48)%]、SDa[(5.57±2.26)%vs(3.11±1.13)%]均較健康對照組明顯增大(P均0.05)。另外,孤立性房顫組中的左心房無擴大亞組的PAL、SRs、ACLS、SRa低于健康對照組(P均0.05),SDs,SDa大于健康對照組(P均0.05)。Logistic回歸分析結(jié)果顯示SDs,SDa能夠較傳統(tǒng)參數(shù)更有效的區(qū)分孤立性房顫和對照組(SDs:敏感度83%,特異度72%;SDa:敏感度81%,特異度76%)。SDs,SDa的增大是預(yù)測孤立性房顫消融術(shù)后復(fù)發(fā)的最佳因素(SDs:敏感度80%,特異度71%;SDa:敏感度86%,特異度79%)。結(jié)論:2D-STE技術(shù)能夠檢測出孤立性房顫患者的左心房功能降低和運動不同步,左心房無擴大的孤立性房顫患者,2D-STE參數(shù)仍有顯著異常。SDs、SDa能夠較傳統(tǒng)參數(shù)更有效的區(qū)分孤立性房顫和健康者,而且是預(yù)測房顫術(shù)后復(fù)發(fā)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 鹵8.57 vs 38.73 鹵6.13), SRs (1.17 鹵0.31 vs 1.57 鹵0.25), ACLS (14.11 鹵4.91vs 18.86 鹵3.57), SRa (-1.41 鹵0.58 vs-1.90 鹵0.30) was significantly lower than that of the healthy control group (P 0.05) (P 0.05), SDs [(8.11 鹵3.00)% vs (4.67 鹵1.48)%], SDa [(5.57 鹵2.26)% vs (3.11 鹵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.
【作者單位】： 大連醫(yī)科大學(xué)附屬第一醫(yī)院心內(nèi)科;大連醫(yī)科大學(xué)附屬第二醫(yī)院重癥監(jiān)護病房;中國醫(yī)科大學(xué)附屬第一醫(yī)院心血管超聲科;
【分類號】：R541.75

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