三维斑点追踪技术评估非瓣膜性心房颤动患者左房低电压区对左房结构及功能的影响  

Evaluation of the effects of left atrial low-voltage area on left atrial function in patients with non-valvular atrial fibrillation by three-dimensional speckle tracking imaging

作　　者：周怡希 何文[1] 张巍[1] 李永佳 张萌 兰亭玉 田颖 位少彬 杜丽娟[1] ZHOU Yixi;HE Wen;ZHANG Wei;LI Yongjia;ZHANG Meng;LAN Tingyu;TIAN Ying;WEI Shaobin;DU Lijuan(Department of Ultrasound,Beijing Tiantan Hospital,Capital Medical University,Beijing 100071,China)

机构地区：[1]首都医科大学附属北京天坛医院超声科,北京市100071 [2]首都医科大学附属北京天坛医院心内科,北京市100071

出　　处：《临床超声医学杂志》2024年第4期317-321,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用三维斑点追踪技术(3D-STI)评估非瓣膜性心房颤动(以下简称房颤)患者不同程度左房低电压区(LVA)对左房结构及功能的影响。方法选取我院拟行射频消融术的非瓣膜性房颤患者66例,术前均行经胸超声心动图检查获得左房收缩末期前后径、左右径、上下径和左室舒张末期内径、左室射血分数、二尖瓣口舒张早期峰值血流速度与二尖瓣环峰值运动速度比值(E/e’);3D-STI获得左房储器期应变(LASr)、管道期应变(LAScd)、泵功能期应变(LASct)及左房射血分数(LAEF)。进行射频消融术时应用三维电解剖标测技术获得LVA,根据LVA面积占左房总面积的百分比定义LVA程度,将患者分为无LVA患者组(Ⅰ组)29例、LVA程度<10%组(Ⅱ组)26例、LVA程度≥10%组(Ⅲ组)11例,比较各组临床资料和超声心动图参数的差异;分析左房应变参数与LVA的相关性。结果Ⅲ组陈旧性脑梗死或一过性脑缺血、持续性房颤占比及CHA_(2)DS_(2)-VASc评分均高于Ⅰ组、Ⅱ组,差异均有统计学意义(均P<0.05)。Ⅰ组与Ⅲ组、Ⅱ组与Ⅲ组E/e’>14者占比比较,差异均有统计学意义(均P<0.05);其余常规超声心动图参数比较,差异均无统计学意义。Ⅲ组LASr、LAScd、LASct、LAEF均低于Ⅰ组、Ⅱ组,差异均有统计学意义(均P<0.05)。相关性分析显示,LASr、LAScd、LASct均与LVA呈负相关(r=-0.538、-0.448、-0.501,均P<0.05)。结论当LVA达到10%时,房颤患者左房结构虽未发生改变,但其功能已经减低;应用3D-STI可以早期发现非瓣膜性房颤患者LVA程度对左房功能的影响。Objective To evaluate the effects of different degrees of left atrial low-voltage area(LVA)on left atrial structure and function in patients with non-valvular atrial fibrillation by three-dimensional speckle tracking imaging(3D-STI).Methods Sixty-six patients with non-valvular atrial fibrillation who underwent radiofrequency ablation in our hospital were enrolled.Transthoracic echocardiography were performed to obtain the left atrial end-systolic anteroposterior diameter,left and right diameter,upper and lower diameter,left ventricular end-diastolic diameter,left ventricular ejection fraction(LVEF),and the ratio of early diastolic peak mitral flow to peak mitral annular velocity(E/e’).The left atrial reservoir phase strain(LASr),pipeline phase strain(LAScd),pump functional phase strain(LASct)and left atrial ejection fraction(LAEF)were measured by 3D-STI.Left atrial LVA was obtained by three-dimensional electro-anatomical mapping during radiofrequency ablation.According to the percentage of LVA to left atrial surface area,the patients were divided into non-LVA group(groupⅠ,29 cases),the degree of LVA<10%(groupⅡ,26 cases)and the degree of LVA≥10%(groupⅢ,11 cases).The clinical data and echocardiography parameters among the three groups were compared.The correlation between left atrial strain parameters and LVA were analyzed.Results The proportion of cerebral infarction or transient cerebral ischemia history,persistent atrial fibrillation and CHA_(2)DS_(2)-VASc score in groupⅢwere all higher than those in groupⅠand groupⅡ,and the differences were statistically significant(all P<0.05).There were statistically significant differences in the proportion of E/e’>14 between groupⅠand groupⅢ,groupⅡand groupⅢ(both P<0.05).There were no significant differences in other conventional echocardiographic parameters.LASr,LAScd,LASct and LAEF in groupⅢwere lower than those in groupⅠand groupⅡ,and the differences were statistically significant(all P<0.05).Correlation analysis showed that LASr,LAScd,LAS

关 键 词：超声心动描记术 斑点追踪 三维 心房颤动 应变 低电压区 左房 

分 类 号：R540.45[医药卫生—心血管疾病] R541.7[医药卫生—内科学]