左心房应变及机械离散度预测心房颤动患者射频消融术后复发的研究  

The study of left atrial strain and mechanical dispersion in predicting the recurrence of patients with atrial fibrillation after radiofrequency catheter ablation

作　　者：沙雨佳 胡倩 周瑜[1] 李丽娜[1] 李世军[2] 王涛[2] 岳庆雄[1] SHA Yu-jia;HU Qian;ZHOU Yu;LI Li-na;LI Shi-jun;WANG Tao;YUE Qing-xiong(Department of Ultrasound Dalian Central Hospital,Dalian 116000,China;Department of Cardiology Dalian Central Hospital,Dalian 116000,China)

机构地区：[1]大连市中心医院超声科,辽宁省大连市116000 [2]大连市中心医院结构心脏病/心律失常一科,辽宁省大连市116000

出　　处：《中国心血管病研究》2022年第1期62-68,共7页Chinese Journal of Cardiovascular Research

基　　金：大连市科技创新基金项目(2021JJ13SN53)。

摘　　要：目的应用二维斑点超声心动图(two-dimensional speckle tracking echocardiography,2DSTE)评价阵发性心房颤动(atrial fibrillation,AF)和持续性房颤患者的左心房总体纵向应变(global left atrial longitudinal strain,GLAS)及机械离散度,评估这两项参数的有效性以及与射频消融术(radiofrequency catheter ablation,RFCA)后房颤复发的临床相关性。方法选取大连市中心医院2018年9月至2020年9月有房颤病史并且确定行射频消融术的患者共93例(持续性房颤28例,阵发性房颤65例)作为研究对象,根据术后是否复发分为复发组和未复发组。所有患者均在术前一天行经胸超声心动图检查并进行常规测量。使用二维斑点追踪技术评估GLAS及左心房机械离散度。左心房机械离散度定义为经R-R间期标化的应变达峰时间标准差(standard deviation of time to peak strain,SD-TPS)。结果无论在持续性房颤组中还是在阵发性房颤组中,复发组的GLAS均低于未复发组[(7.5±2.0)%比(13.2±3.7)%,(13.6±6.4)%比(21.9±6.5)%,P<0.05],且复发组的SD-TPS均高于未复发组[(8.0±1.7)ms比(5.8±2.2)ms,(8.2±2.6)ms比(6.2±2.5)ms,P<0.05]。在Cox比例风险分析中,GLAS和SD-TPS均是持续性房颤组(HR=0.81,95%CI 0.68~0.94,P=0.009;HR=1.24,95%CI 1.01~1.47,P=0.018)及阵发性房颤组(HR=0.73,95%CI 0.60~0.89,P=0.002;HR=1.86,95%CI1.14~3.03,P=0.013)中射频消融术后最能有效预测房颤复发的参数。ROC曲线显示,GLAS在持续性房颤组和阵发性房颤组中预测术后复发的截点值分别为8.72%和15.16%;SD-TPS在持续性房颤组和阵发性房颤组中预测术后复发的截点值为6.27 ms和6.41 ms。结论无论在阵发性房颤还是持续性房颤患者中,通过二维斑点追踪技术评价左心房整体纵向应变以及机械离散度都有助于识别射频消融术后房颤复发的高风险患者,进而指导临床的用药和治疗。Objective To evaluate the global left atrial longitudinal strain(GLAS) and mechanical dispersion of the left atrium and explore the effectiveness of these two parameters on the recurrence of atrial fibrillation after radiofrequency catheter ablation(RFCA).Methods A total of 93 patients(28 cases of persistent atrial fibrillation and 65 cases of paroxysmal atrial fibrillation) who had a history of atrial fibrillation and confirmed to undergo radiofrequency ablation from September 2018 to September 2020 in Dalian Central Hospital were selected as the research objects.The patients was divided into the recurrence group and non-recurrence group according to the postoperative recurrence.All patients underwent transthoracic echocardiography and routine measurements one day before the surgery.Two-dimensional speckle tracking technology(2 DSTE) was used to evaluate the mechanical dispersion of GLAS and the left atrium.The mechanical dispersion of the left atrium was defined as the standard deviation of time to peak strain(SD-TPS) standardized by the R-R interval.Results Both in the persistent atrial fibrillation or in the paroxysmal atrial fibrillation,the GLAS of the relapsed group was lower than that of the non-relapsed group [(7.5±2.0)% vs.(13.2±3.7)%,(13.6±6.4)% vs.(21.9±6.5)%,P<0.05],and the SD-TPS of the relapsed group was higher than that of the non-relapsed group [(8.0±1.7)ms vs.(5.8±2.2)ms,(8.2±2.6)ms vs.(6.2 ± 2.5)ms,P<0.05].In the cox proportional hazard analysis,GLAS and SD-TPS were both the effectivest predictor of atrial fibrillation recurrence after radiofrequency ablation in the persistent atrial fibrillation group(HR=0.81,95%CI 0.68~0.94,P=0.009;HR=1.24,95%CI 1.01~1.47,P=0.018) and paroxysmal atrial fibrillation group(HR=0.73,95%CI 0.60~0.89,P=0.002;HR=1.86,95%CI 1.14~3.03,P=0.013).The ROC curve showed that the cut-off points of GLAS for predicting postoperative recurrence in the persistent atrial fibrillation group and paroxysmal atrial fibrillation group were 8.72% and 15.16%,respectively.The cut

关 键 词：二维斑点超声心动图 心房颤动 射频消融术 左心房应变 运动同步性 

分 类 号：R541.7[医药卫生—心血管疾病]