基于相邻RR间期比值接近1之后紧接的单次心搏测定持续性心房颤动患者左心室收缩功能的准确性  

Assessment of left ventricular systolic function in patients with persistent atrial fibrillation using the single beat method based on the ratio of preceding R-R intervals approaching to 1

作　　者：马改改[1] 方理刚[1] 林雪[1] 徐瑞燚[1] 方全[1] Ma Gaigai;Fang Ligang;Lin Xue;Xu Ruiyi;Fang Quan(Department of Cardiology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院心内科,100730

出　　处：《中华超声影像学杂志》2019年第8期656-662,共7页Chinese Journal of Ultrasonography

摘　　要：目的观察持续性心房颤动(房颤)患者不同RR间期对超声心动图测量左室收缩功能的影响,评估基于相邻RR间期比值接近1之后紧接的单次心搏测定持续房颤患者左室收缩功能的准确性。方法对21例持续性房颤患者行超声心动图检查,每例患者分别存储至少连续10~20个心动周期的图像,测量不同RR间期时左室射血分数(LVEF)和每搏输出量(SV),分析不同RR间期对于超声心动图测定LVEF和SV的影响。以多个心动周期测定值的平均值为金标准,评估基于相邻RR间期比值接近1之后紧接的单次心搏测定持续房颤患者左室收缩功能的准确性。结果同一房颤患者在不同心动周期测得的LVEF和SV变异较大。LVEF和SV不仅与心率快慢有关,还与相邻RR间期(RR1)呈显著正相关(均r>0.4,均P<0.05);同时也受房颤心律规整程度的影响,当心率变异程度较大时(心率标准差≥30次/min),与RR1相比,所测得SV与该心搏前相邻RR间期比值(RR1/RR2)呈更好的相关性(r:0.581对0.835,P=0.009)。与多个心动周期测定值的平均值比较,基于相邻RR间期比值接近1(0.90~1.10)之后紧接的单次心搏测定所得的LVEF和SV与平均值呈显著正相关(r=0.897,0.918;均P<0.001),Bland-Altman分析显示两者一致性较好。结论房颤时左室收缩功能参数测定不仅与心率快慢有关,还受心律规整程度的影响。基于相邻RR间期比值接近1之后紧接的单次心搏测定持续房颤患者左室收缩功能,其准确性与传统多个心动周期测定值的平均值相当。Objective To observe the effect of different R-R interval on left ventricular systolic function measured by echocardiography in patients with persistent atrial fibrillation (AF), and assess the clinical feasibility of the use of an index that is based on the RR1/RR2 ratio to accurately estimate left ventricular systolic function during AF. Methods Twenty-one patients with persistent AF received echocardiographic examination, left ventricular ejection fraction (LVEF) and stroke volume (SV) were recorded at least 10-20 consecutive cardiac cycles for each patient. The effects of different R-R intervals on LVEF and SV determined by echocardiography were analyzed. Bland-Altman analysis was used to assess the correlation and agreement between the systolic parameters of a single beat method based on the ratio of preceding R-R intervals approaching to 1 and the average value of multiple cardiac cycles as the golden standard. Results In the same patient with AF, LVEF and SV measured in different cardiac cycles were unstable with great variation. LVEF and SV were not only correlated with heart rate, showing significantly positive correlations with RR interval (all r>0.4, P<0.05);which were also affected by heart rate variability, when the heart rate variability was high (heart rate standard deviation≥30 beats/min), the measured SV was better correlated with RR1/RR2 (r: 0.581 vs 0.835, P=0.009). Bland-Altman analysis showed excellent correlation and agreement between the LVEF and SV of a single beat with identical RR1and RR2 intervals and measured average values over all cardiac cycles (r=0.897, 0.918;all P<0.001). Conclusions LV systolic function is significantly correlated with RR interval and is also affected by heat rate variability. Single beat based on ratio of RR1/RR2 to assess LV systolic function in patients with AF is as accurate as the time-consuming method of averaging multiple cardiac cycles.

关 键 词：超声心动描记术 心房颤动 心室功能 左 RR间期比值 单次心搏 

分 类 号：R541.75[医药卫生—心血管疾病]