风湿性心脏病合并心房颤动患者左心耳应变率与其纤维化程度的相关性研究  

Correlation of the strain rate of left atrial appendage with myocardial fibrosis in patients with rheumatic heart disease complicated with atrial fibrillation

作　　者：孙恒 周军[1] 张松林[2] 刘蓉[1] 徐亮[1] 许涛 周畅[1] SUN Heng;ZHOU Jun;ZHANG Songlin;LIU Rong;XU Liang;XU Tao;ZHOU Chang(Department of Ultrasound,Yichang Central People’s Hospital,the First Clinical College of Clinical Three Gorges University,Hubei 443003,China)

机构地区：[1]三峡大学第一临床医学院,宜昌市中心人民医院超声科,湖北省宜昌市443003 [2]三峡大学第一临床医学院,宜昌市中心人民医院胸心外科,湖北省宜昌市443003

出　　处：《临床超声医学杂志》2022年第8期572-577,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用二维斑点追踪技术检测风湿性心脏病合并心房颤动(以下简称房颤)患者左心耳应变率,探讨其与左心耳纤维化程度的相关性。方法选取我院接受心脏瓣膜置换术+心脏射频消融改良迷宫术的风湿性心脏病合并房颤患者36例,术前均行经食管超声心动图检查测得左心耳应变率,术中获取左心耳组织进行组织病理学检查。根据术后6个月随访情况,分为房颤复发组8例和非复发组28例,比较两组左心耳基底段、中间段、顶段及整体应变率,以及左心耳分段和整体纤维化程度;分析左心耳应变率与其纤维化程度的相关性。结果复发组收缩期左心耳整体应变率及左心耳基底段、顶段应变率均低于非复发组[(1.2±1.0)s^(-1) vs.(2.1±0.8)s^(-1),(0.8±0.4)s^(-1) vs.(1.5±0.5)s^(-1),(1.5±1.0)s^(-1) vs.(2.7±1.1)s^(-1)],左心耳整体及基底段、顶段纤维化程度均较非复发组更高,差异均有统计学意义(均P<0.05)。所有患者左心耳整体应变率与其纤维化程度呈负相关(r=-0.766,P<0.01);左心耳基底段、中间段、顶段应变率与对应分段的纤维化程度均呈负相关(r=-0.752、-0.547、-0.589,均P<0.01)。结论风湿性心脏病合并房颤患者左心耳应变率与其纤维化程度呈负相关,其中左心耳基底段应变率与其分段纤维化程度的相关性较显著。Objective To detect the strain rate of left atrial appendage(LAA)in patients with rheumatic heart disease(RHD)complicated with atrial fibrillation(AF)by two-dimensional speckle tracking imaging,and to detect its correlation with degree of LAA fibrosis.Methods A total of 36 patients with RHD complicated with AF who underwent valve replacement combined with cardiac radiofrequency ablation in our hospital were included.The strain rate of LAA was measured by transesophageal echocardiography before operation,and the LAA tissues obtained during operation were examined by histopathology.The patients were divided into recurrent AF group(n=8)and non-recurrent group(n=28)according to the situation of the follow-up 6 months after operation,the basal,intermediate,apical,global LAA strain rate and the degree of segmental,global fibrosis of LAA between the two groups were compared.The correlation between the strain rate of LAA and the degree of LAA fibrosis was analyzed.Results Compared with the non-recurrent group,the global,basal and apical LAA strain rate were lower than those in the recurrent group[(1.2±1.0)s^(-1) vs.(2.1±0.8)s^(-1),(0.8±0.4)s^(-1) vs.(1.5±0.5)s^(-1),(1.5±1.0)s^(-1) vs.(2.7±1.1)s^(-1)],and the degree of the global,basal and apical fibrosis of LAA were more serious in recurrent group than those in non-recurrent group,and the difference were statistically significant(all P<0.05).The global LAA strain rate was negatively correlated with the degree of LAA fibrosis in all patients(r=-0.766,P<0.01).The basal,intermediate and apical LAA strain rate were negatively correlated with the degree of LAA fibrosis in the corresponding segments(r=-0.752,-0.547,-0.589,all P<0.01).Conclusion The strain rate of LAA is negatively correlated with the degree of myocardial fibrosis in patients with RHD complicated with AF,the correlation of the basal LAA strain rate and the degree of LAA fibrosis is the most significant.

关 键 词：超声心动描记术 斑点追踪 二维 心房颤动 应变率 左心耳 心肌纤维化 

分 类 号：R540.45[医药卫生—心血管疾病] R541.2[医药卫生—内科学]