斑点追踪技术评价心房颤动患者左心房重构及预测射频消融术疗效的研究  

Evaluating of left atrial remodeling and predicting the efficacy of radiofrequency catheter ablation with atrial fibrillation by speckle tracking imaging

作　　者：钟小芳[1] 苏茂龙[1] 黄卫斌 陈超 王晶 郭骏[4] 

机构地区：[1]厦门大学附属中山医院福建医科大学厦门中山教学医院超声医学科,361004 [2]厦门市心血管病医院心内科 [3]厦门中医院心内科 [4]福建医科大学协和临床医学院

出　　处：《中华超声影像学杂志》2015年第5期382-386,共5页Chinese Journal of Ultrasonography

基　　金：福建省自然科学基金项目（2014J01438）;厦门市科技局科技项目（3502220114014）

摘　　要：目的应用斑点追踪技术评价持续性心房颤动（房颤）患者左房结构功能变化，并对经导管射频消融术6个月后房颤复发的可能性进行临床预测研究。方法对25例健康志愿者和45例持续性房颤患者的左房结构功能及应变率进行分析，分别于经导管射频消融术前1周、术后24h、术后3个月、术后6个月测量并计算左房前后径（LADI）、左房面积（LAAI）、左房最大容积（LAVImax）、左房射血分数（LAEF）和左室收缩期左房应变率（SRs）、左室舒张早期左房应变率（SRe）、左房收缩期应变率（SRa）及左房壁15节段的平均应变率。结果①与对照组相比，房颤组LADI、LAAI、LAVImax均明显增大，LAEF、左房壁SRs、SRe及左房壁平均SRs、SRe均明显减低，左房壁SRa及平均SRa均消失。②房颤组术后恢复窦性心律并随访至6个月，LADI、LAAI、LAVImax逐渐减小，LAEF、左房壁SRs、SRa、SRe及平均SRa、SRs、SRe均逐渐增高。③平均SRs预测房颤术后维持窦性心律的优势比、95％CI及校正P值分别为0．607、0．471-0．819、0．017。结论斑点追踪技术可定量评价持续性房颤患者射频消融术前后左房功能的动态演变过程；反映左房整体储存功能的左房平均SRs可以预测持续性房颤患者射频消融术后近期疗效。Objective To evaluate left atrial function dynamic changes before and after radiofrequency catheter ablation （CA） with persistent atrial fibrillation （AF） and predict the maintain sinus rhythm of postoperative atrial fibrillation by speckle tracking imaging. Methods The study was including 45 cases underwent CA with persistent AF（preoperative 1 week,postoperative 24 hours,3 months,6 months） and 25 normal cases. Left atrial function and strain rate were analysed. These index were measured and calculated： the left atrial diameter index（LADI）, left atrial area index（LAAI）, left atrial maximum volume index （LAVImax） and left atrial ejection fraction（LAEF）,left atrial wall strain rate of left ventricular systolie （SRs） ,left atrial wall strain rate of left ventricular early diastolic （SRe） ,left atrial systolic strain rate（SRa） and the average of left atrial wall each phase strain rate. Results ① LADI, LAAI, LAVImax were significantly increased; LAEF, SRs, SRe were decreased significantly; SRa were disappeared with AF compared with the control group. ② LADI, LAAI, LAVImax decreased gradually, LAEF, SRs, SRe, SRa were gradually increased with the extension of the follow-up time. ③ Left atrial average SRs predicted maintenance of sinus rhythm with atrial fibrillation after operation of CA（odds ratio = 0.607,95% CI = 0.417- 0.819,correction of P = 0.017） was an independent predictor. Conclusions Speckle tracking imaging can quantitative evaluate left atrial function with persistent AF after CA. Left atrial global reservoir function predicts the efficacy of CA.

关 键 词：超声心动图描记术 心房颤动 心房功能 左 斑点追踪显像 

分 类 号：R541.75[医药卫生—心血管疾病] R540.45[医药卫生—内科学]