三维超声心动图及二维斑点追踪成像对持续性心房颤动复律后双心房逆向重构的评估  

Biatrial structure and function reverse remodelling in patients with persistent atrial fibrillation after cardioversion:evidence from three dimensional echocardiography and two dimensional speckle tracking imaging

作　　者：刘丹妮 敖梦[1] 冉海涛[1] 李世玉 秦芳 Liu Danni;Ao Meng;Ran Haitao;Li Shiyu;Qin Fang(Department of Ultrasound,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Cardiology,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院超声科(超声分子影像重庆市重点实验室),400010 [2]重庆医科大学附属第二医院心内科,400010

出　　处：《中华医学超声杂志（电子版）》2023年第8期827-835,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金(81630047);重庆医科大学附属第二医院“宽仁英才”项目。

摘　　要：目的应用实时三维超声心动图(RT3DE)及二维斑点追踪成像(2DSTI)技术评估持续性心房颤动(PeAF)复律后窦性心律维持者双心房内径、容积、应变的变化,探讨双心房结构和功能的逆向重构。方法这是一项前瞻性研究。纳入2020年8月至2021年12月于重庆医科大学附属第二医院心内科成功复律且随访3个月未复发的PeAF患者21例(病例组),以及在重庆医科大学附属第二医院体检的18例健康志愿者(正常对照组)。应用常规超声、RT3DE、2DSTI对其进行心房结构和功能的评估,21例PeAF患者分别于复律后2 d(M0)、1个月(M1)、3个月(M3)进行超声评估。评估包括二维参数:左心房前后径(LAAPD)、左心房左右径(LALRD)、左心房上下径(LASID)、右心房横径(RACD)、左心室射血分数(LVEF)、二尖瓣口舒张早期峰值流速/二尖瓣环舒张早期峰值运动速度(E/e');双心房三维容积及容积指数:左心房/右心房最大容积(LAVmax/RAVmax)、左心房/右心房P波前容积(LAVpre/RAVpre)、左心房/右心房最小容积(LAVmin/RAVmin)、左心房/右心房最大容积指数(LAVImax/RAVImax)、左心房/右心房P波前容积指数(LAVIpre/RAVIpre)、左心房/右心房最小容积指数(LAVImin/RAVImin);三维射血分数:左心房/右心房总射血分数(LATEF/RATEF)、左心房/右心房被动射血分数(LAPEF/RAPEF)、左心房/右心房主动射血分数(LAAEF/RAAEF);三维扩张指数:左心房/右心房扩张指数(LAEI/RAEI);二维心房应变:左心房/右心房储存期应变(LASr/RASr)、左心房/右心房管道期应变(LAScd/RAScd)、左心房/右心房收缩期应变(LASct/RASct)。对比分析正常对照组与病例组M0、M1、M3各组间参数的差异。结果PeAF复律后,随着窦性心律维持时间延长,二维参数LAAPD、LALRD、LASID、RACD,双心房容积及容积指数LAVmax/RAVmax、LAVpre/RAVpre、LAVmin/RAVmin、LAVImax/RAVImax、LAVIpre/RAVIpre、LAVImin/RAVImin逐渐减小(P均<0.05);双心房应变LASr/RASr、LASObjective To explore the bilateral atrial structure and function reverse remodelling by using real-time three dimensional echocardiography(RT3DE)and two dimensional speckle tracking imaging(2DSTI)to evaluate the biatrial diameter,volume,and function changes in persistent atrial fibrillation(PeAF)patients with sinus rhythm after cardioversion.Methods This is a prospective study in which 21 patients with PeAF who had been successfully cardioverted at the Cardiology Department of the Second Affiliated Hospital of Chongqing Medical University from August 2020 to December 2021 with no recurrence after 3 months of follow-up were included(case group),as well as 18 healthy volunteers(healthy control group)who underwent physical examination at the Second Affiliated Hospital of Chongqing Medical University.The subjects had their atrial diameter,volume,and function evaluated by conventional ultrasound,RT3DE,and 2DSTI.Patients with PeAF were assessed at 2 days(M0),1 month(M1),and 3 months(M3)after cardioversion.The right atrial and left atrial parameters assessed included:left atrial anteroposterior diameter(LAAPD),left atrial left-right diameter(LALRD),left atrial superior-inferior diameter(LASID),right atrial transverse diameter(RATD),left ventricular ejection fraction(LVEF),the ratio of early diastolic mitral inflow velocity to early diastolic myocardial relaxation velocity(E/e'),left atrial/right atrial maximal volume(LAVmax/RAVmax),left atrial/right atrial pre-P wave volume(LAVpre/RAVpre),left atrial/right atrial minimal volume(LAVmin/RAVmin),left atrial/right atrial maximal volume index(LAVImax/RAVImax),left atrial/right atrial pre-P wave volume index(LAVIpre/RAVIpre),left atrial/right atrial minimal volume index(LAVImin/RAVImin),left atrial/right atrial total ejection fraction(LATEF/RATEF),left atrial/right atrial passive ejection fraction(LAPEF/RAPEF),left atrial/right atrial active ejection fraction(LAAEF/RAAEF),left atrial/right atrial expansion index(LAEI/RAEI),left atrial/right atrial strain during reservoir phas

关 键 词：心房颤动 心脏复律 窦性心律 三维超声心动图 二维斑点追踪成像 心房重构 

分 类 号：R541.75[医药卫生—心血管疾病] R540.45[医药卫生—内科学]