经食管超声心动图多参数评估心房颤动患者左心耳功能  

Evaluation of left atrial appendage functions using multiple parameters by transesophageal echocardiography

作　　者：张盛敏[1] 许幼峰[1] 俞霏[1] 毛锋[1] 陈立斌[1] 郭旻华[1] 曹涌[1] 陈伟英[1] 储慧民[2] 

机构地区：[1]宁波市第一医院超声科,315010 [2]宁波市第一医院心内科,315010

出　　处：《中华超声影像学杂志》2015年第6期486-491,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨三维容积法左心耳排空分数、左心耳壁心肌组织速度在左心耳功能评估中的应用价值。方法连续选取心房颤动患者76例，应用经食管超声心动图测量二维面积法和三维容积法左心耳排空分数、左心耳最大排空流速、以及左心耳三个位点（内、外侧壁中点及尖部）的组织速度，行统计分析。结果①超声检查中心律为窦性者上述6个参数值均高于房颤者（P均〈0．05），不伴左心耳内自发声学显影者6个参数值均高于伴自发声学显影者（P均do．05）；②三维、二维法排空分数相关性好（r=0．727），且二者与左心耳最大排空流速的相关系数近似（二维法：r=0．685、三维法：r=0．632）；③左心耳组织速度中，尖部测值较另两个位点更高（P均为0．000），且与其他参数的相关性亦更好。结论三维容积法测量左心耳排空分数切实可行，结果可靠；左心耳壁组织速度的最佳取样位点为心耳尖部。Objective To discuss the feasibility and accuracy of left atrial appendage （LAA） ejection fraction by real-time 3 dimensional imaging （3D-EF） ,and tissue velocity of the LAA wall by tissue Doppler imaging （TDI） via transesophageal echocardiography （TEE） in assessing LAA functions. Methods A total number of 76 patients with atrial fibrillation （AF） were included in the study consecutively and underwent TEE for LAA investigations. 3D-EF, fractional area change by 2 dimensional imaging （2D-FAC）, peak emptying velocity （PEV）, LAA tissue velocity by TDI at the mid-portion of lateral wall （TDI-L）, mid- portion of septal wall （TDI-S） and the apical tip （TDI-A） were calculated. Results Statistic analysis showed the following results： 1） 2D-FAC, 3D-EF, PEV, TDI-L, TDI-S and TDI-A were all significantly higher in patients with sinus rhythm than those with AF during the TEE examinations （all P 〈0.05）,and significantly higher in patients without spontaneous echo contrast （SEC） than those who had SEC （all P 0.05） ;2） The results of 3D-EF showed a good correlation with 2D-FAC （ r = 0.727, P = 0.000） ,and their correlations with PEV were similar （2D-FAC and PEV： r = 0.685;3D-EF and PEV： r = 0.632,both P = 0.000） 3）TDI-A [（14.95±4.63）cm/s] were significantly higher than TDI-L [-（12.62 ± 3.96） cm/s] and TDI-S [（12.68 ± 3.59）cm/s] （both P = 0.000）. The correlations of TDI-A with PEV,2D-FAC and 3D-EF were all marked higher than those of TDI-L and TDI-S （with PEV： r = 0.840 vs r = 0.564, r = 0.524;with 2D-FAC： r =0.701 vsr =0.486, r =0.504;with3D-EF： r =0.753 vsr =0.493,r =0.522,allP 〈0.05）. Conclusions 3D TEE is feasible and reliable in assessing LAA emptying function. The best location for LAA tissue velocity evaluation is the apical tip.

关 键 词：超声心动描记术 经食管 实时三维 左心耳 

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