心房颤动合并卒中患者的左心房功能与左心房低电压区的相关性研究  

Correlation between left atrial function and the left atrial low voltage zones in patients with atrial fibrillation and stroke

作　　者：吴婷婷 吴楠 王可欣 居维竹 陈明龙 王子盾 Wu Tingting;Wu Nan;Wang Kexin;Ju Weizhu;Chen Minglong;Wang Zidun(Department of Cardiology,The First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China;Gusu School,Nanjing Medical University,Suzhou 215000,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)心血管内科,南京210029 [2]南京医科大学姑苏学院,南京215000

出　　处：《中华心脏与心律电子杂志》2022年第4期231-237,共7页Chinese Journal of Heart and Heart Rhythm(Electronic Edition)

摘　　要：目的评估非瓣膜性心房颤动(房颤)合并脑卒中患者的左心房功能与左心房低电压区的相关性。方法入选2022年4月1日至9月30日南京医科大学第一附属医院心血管内科心律失常病区收治的房颤合并卒中患者。用超声心动图评估左心房的功能[如左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房容积指数(LAVI)等],用消融术后窦性心律下的三维基质标测评估左心房内膜面的低电压区(LVZs),并根据LVZs面积分为有LVZs组(总LVZs面积比例>5%;)和无LVZs组(总LVZs面积比例≤5%),分析左心房功能与LVZs之间的相关性。结果共入选患者26例,年龄(60.77±10.31)岁,其中女8例(30.77%,8/26),有LVZs组7例,无LVZs组19例。与无LVZs组相比,有LVZs组患者中女性多[71.4%(5/7)对15.8%(3/19),P=0.014],CHA2DS2-VASc评分更高(6分对3分,P=0.039);LAVmax[(118.43±37.67)ml对(88.11±30.00)ml,P=0.043]与LAVmin[(97.00±37.59)ml对(54.89±29.42)ml,P=0.006]均大、LAVI大[65(59,71)对44(34,58),P=0.004]、左心房射血分数(LAEF)低(18.93%±8.30%对40.39%±15.66%,P=0.002)、左心房储存功能差[21.98(12.22,37.04)%对64.52(38.57,111.43)%,P=0.002]。多因素回归分析提示女性(OR=54.814,95%CI 1.104~2721.590,P=0.044)、低LAEF(OR=0.822,95%CI 0.696~0.970,P=0.020)是左心房存在明显LVZs的独立危险因素。结论基于超声心动图评价的左心房功能可以在一定程度上预测房颤合并卒中患者的左心房LVZs水平,从而指导射频消融策略。Objective To explore the correlation between left atrial function and the left atrial low-voltage zones(LVZs)in patients with nonvalvular atrial fibrillation and stroke.Methods Patients with atrial fibrillation and stroke who admitted to the department of cardiology,The First Affiliated Hospital with Nanjing Medical University were enrolled from April 1st to September 30th,2022.A pre-procedural echocardiography was performed to assess the left atrial function,such as the max of left atrial volume(LAVmax),the minimum of left atrial volume(LAVmin),the index of left atrial volume(LAVI),and detailed voltage mapping by an electro-anatomical mapping system was applied to evaluate the LA LVZs.Patients were divided into two groups according to the presence of the LVZs:LVZs group(LVZs ratio>5%)and no LVZs group(LVZs ratio≤5%).The correlation between the LVZs and left atrial function was then analyzed.Results There were 26 patients enrolled totally,aged(60.77±10.31)years,8 female(30.77%,8/26),7 in LVZs group,19 in no LVZs group.Compared to no LVZs group,the patients in LVZs group presented more women[71.4%(5/7)vs.15.8%(3/19),P=0.014]and higher CHA2DS2-VASc scores(6 vs.3,P=0.039).Echocardiography showed larger LAV max[(118.43±37.67)ml vs.(88.11±30.00)ml,P=0.043],larger LAV min[(97.00±37.59)ml vs.(54.89±29.42)ml,P=0.006],higher LAVI(65 vs.44,P=0.004),lower LAEF(18.93%±8.30%vs.40.39%±15.66%,P=0.002)and worse Reservoir function[21.98(12.22,37.04)%vs.64.52(38.57,111.43)%,P=0.002].Multivariable logistic regression analyses revealed female(OR=54.814,95%CI 1.104-2721.590,P=0.044),lower LAEF(OR=0.822,95%CI 0.696-0.970,P=0.020)to be independent predictors of the presence of LVZs.Conclusion Echocardiography-based assessment of left atrial function can predict the level of the left atrial LVZs in patients with atrial fibrillation and stroke,thereby guiding subsequent ablation strategies.

关 键 词：心房颤动 左心房功能 低电压区 超声心动图 

分 类 号：R541.75[医药卫生—心血管疾病]