实时三维超声和二维斑点追踪成像对不同时期心房颤动患者左房结构和功能的评价  

Evaluation of left atrial structure and function in atrial fibrillation patients during atrial fibrillation and sinus rhythm by real-time three-dimensional echocardiography and speckle tracking imaging

作　　者：罗田田[1] 张萍[1] 任建丽[1] 王志刚[1] 张兰[1] 温朝美 

机构地区：[1]重庆医科大学超声影像学研究所及附属第二医院超声科超声分子影像重庆市重点实验室,重庆400010

出　　处：《临床心血管病杂志》2016年第5期475-479,共5页Journal of Clinical Cardiology

基　　金：国家自然科学基金面上项目(No:81071158)

摘　　要：目的:采用实时三维超声心动图(RT-3DE)和二维斑点追踪成像(2D-STI)评价不同时期心房颤动(房颤)患者的左房结构和功能。方法:分别对24例健康对照组和48例房颤患者(房颤间歇期为AFl组,发作期为AF2组)行超声心动图检查。应用RT-3DE计算左房最大容积指数(LAVImax)、左房最小容积指数(LAVImin)、左房收缩前容积指数(LAVIp)、左房总射血分数(LATEF)、左房扩张指数(LAEI)、左房被动射血分数(LAPEF)和左房主动射血分数(LAAEF);应用2D-STI获取左房壁各节段的应变-时间曲线,测量收缩期、舒张早期和舒张晚期的左房平均峰值应变(mSs、mSe、mSa)、峰值应变率(mSRs、mSRe、mSRa),并计算左房僵硬度(LASt)。结果:与对照组比较,AFl组和AF2组左房内径(LAD)、左房容积指数(LAVI)增大,mSs、mSe、mSRs减低(均P<0.05),且AF2组更明显,mSRe在AF1和对照组间差异无统计学意义。AF1组mSa、mSRa减低(均P<0.01),AF2组mSa、mSRa消失,LASt增高(均P<0.01)。LASt与LAVImax、LAVImin呈正相关,与LATEF、LAEI、mSs、mSRs、mSe、mSRe呈负相关。结论:房颤患者左房容积增大。房颤间歇期左房储存功能及辅泵功能降低;发作期左房辅泵功能消失,储存功能及管道功能降低,左房僵硬度增高。左房僵硬度与LAVImax、LAVImin、左房储存功能、管道功能相关。Objective：To evaluate left atrial（LA）structure and function in atrial fibrillation（AF）patients during AF and sinus rhythm by real-time three-dimensional echocardiography（RT-3DE）and two-dimensional speckle tracking imaging（2D-STI）.Method：Forty eight patients with AF and twenty four healthy controls were studied.The AFs were divided into two groups,group AFl during sinus rhythm and group AF2 during AF.The LA maximal,minimal and pre-systolic volume index（LAVI max,LAVImin,LAVIp）,LA total ejection fraction（LATEF）,LA expansion index（LAEI）,LA passive ejection fraction（LAPEF）,LA active ejection fraction（LAAEF）were measured by RT-3DE.The mean peak longitudinal LA strain（mSs,mSe,mSa）,strain rate（mSRs,mSRe,mSRa）and LA stiffness（LASt）were measured on the strain-time curve acquired by 2D-STI.Result：Both group AF1 and AF2showed increased LAD,LAVI and decreased mSs,mSe,mSRs（all P〈0.05）.Sa and SRa were decreased in AF1group（all P〈0.01）.Patients in AF2 group had disappeared Sa,SRa and increased LASt（all P〈0.01）.LASt showed a positive correlation with LAVImax and LAVImin but a negative correlation with LATEF,LAEI,mSs,mSRs,mSe and mSRe.Conclusion：Patients with AFs have enlarged LA.AF patients during sinus rhythm have decreased reservoir and booster pump function.The booster pump function will disappear during AF and there are worse reservoir and conduit function and increased stiffness in AF2 group.LA stiffness is significantly related with LAVImax,LAVImin,LA reservoir function and conduit function.

关 键 词：超声心动描记术 心房颤动 左心房 二维斑点追踪显像 

分 类 号：R541.7[医药卫生—心血管疾病]