应用血流斑点追踪超声分析非瓣膜病心房颤动患者左心耳涡流的特点及其与缺血性脑卒中的相关性  

BST echocardiography for evaluating the characteristics of left atrial appendage vortex and its relationship with ischemic stroke in patients with nonvalvular atrial fibrillation

作　　者：王晓冰[1] 董天心 王永槐[1] 马春燕[1] WANG Xiao-bing;DONG Tian-xin;WANG Yong-huai;MA Chun-yan(Department of Cardiovascular Ultrasound,the First Hospital of China Medical University,Shenyang 11000l,China)

机构地区：[1]中国医科大学附属第一医院心血管超声科,辽宁沈阳110001

出　　处：《中国临床医学影像杂志》2023年第8期571-574,579,共5页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金联合基金项目(编号U21A20387)。

摘　　要：目的:应用血流斑点追踪(BST)技术研究非瓣膜病心房颤动(AF)患者左心耳内涡流特点,并分析涡流与缺血性脑卒中的相关性。方法:选择2021年8月1日—9月30日接受经食管超声心动图检查的非瓣膜病AF患者,根据缺血性脑卒中病史分为脑卒中组和非脑卒中组;选择同期行经食管超声心动图的无AF和瓣膜病的受检者作为对照组。应用BST观察左心耳内涡流分布,分析涡流与缺血性脑卒中以及左心耳结构和功能的相关性。结果:(1)共纳入AF患者28例,其中脑卒中组10例,非脑卒中组18例。对照组15例。(2)非脑卒中组8例患者和对照组7例患者的左心耳内可见涡流,存在涡流的左心耳形态均为鸡翅型。(3)AF患者中涡流与缺血性脑卒中风险相关(P<0.001)。(4)在鸡翅型左心耳形态的患者中,涡流与左心耳收缩速度、排空速度和震荡波速度相关(P<0.001)。结论:BST技术可以显示左心耳内的涡流模式,涡流只出现在鸡翅型左心耳中并与左心耳血流速度相关,涡流与AF缺血性脑卒中相关,可能为AF缺血性脑卒中提供了一个新的预测指标。Objective:To investigate the characteristics of left atrial appendage vortex in patients with nonvalvular atrial fibrillation(AF)using blood speckle tracking(BST)echocardiography,and to analyze its relationship with ischemic stroke.Methods:The patients with nonvalvular AF were collected and divided into a stroke group and a non-stroke group.Meanwhile,the patients without AF and valvular disease served as a control group.The characteristics of left atrial appendage vortex were investigated by BST echocardiography,and the correlation between the vortex and ischemic stroke were analyzed.Results:(1)Twenty-eight AF patients were included,10 in the stroke group(group A)and 18 in the non-stroke group(group B).Fifteen cases were in control group(group C).(2)Vortex was visible in the left atrial appendage of 8 patients in group B and 7 patients in group C,and the left atrial appendage with vortex was chicken-wing type.(3)Vortex was significantly correlated with the risk of ischemic stroke in patients with AF(P0.001).(4)In patients with left atrial appendage of chicken-wing type,vortex was correlated with left atrial appendage evacuation velocity,filling velocity,and reflection velocity(P 0.001).Conclusion:BST echocardiography can visualize the vortex in left atrial appendage.The vortex only appears in the left atrial appendage of chicken-wing type and is correlated with the left atrial appendage flow velocity.The left atrial appendage vortex is correlated with ischemic stroke in AF and thus may provide a new predictor for ischemic stroke in AF.

关 键 词：卒中 心房颤动 超声检查 多普勒 彩色 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学] R540.45