二尖瓣环运动受损对持续性心房颤动患者心房功能性二尖瓣反流的影响  

Impact of impaired mitral annular motor on atrial functional mitral regurgitation in patients with persistent atrial fibrillation

作　　者：张妮 胡倩[1] 周瑜[1] 岳庆雄 ZHANG Ni;HU Qian;ZHOU Yu;YUE Qingxiong(Department of Ultrasound,Central Hospital of Dalian University of Technology,Dalian 116033,China)

机构地区：[1]大连理工大学附属中心医院(大连市中心医院)超声科,辽宁大连116033

出　　处：《中国介入影像与治疗学》2024年第8期468-472,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：大连市中心医院“登峰计划”院内自主立项项目(2022ZZ230)。

摘　　要：目的 观察二尖瓣环运动受损对持续性心房颤动(AF)患者心房功能性二尖瓣反流(AFMR)的影响。方法前瞻性纳入44例接受射频消融(RFA)治疗的持续性AF患者,对比RFA前1日与RFA后3个月二维经胸超声心动图和经食管实时三维超声心动图(RT-3D TEE)参数;根据二尖瓣有效反流口面积(EROA)评估AFMR,计算总体瓣环面积(AA)变化率及收缩前期AA变化率;以RFA前后EROA差值为因变量,筛选影响RFA后3个月AFMR改善程度的治疗前超声相关因素。结果 相比治疗前,RFA后3个月左心房整体纵向应变及左心室射血分数均升高,左心房内径、左心房容积、EROA、瓣环前后径、瓣环周长、AA、瓣叶面积及非平面角均缩小,而总体AA变化率及收缩前期AA变化率均增大(P均<0.05)。RFA前收缩前期AA变化率为持续性AF患者RFA后3个月AFMR改善程度的独立影响因素(P<0.05)。结论 持续性AF患者二尖瓣环运动功能受损主要表现为收缩前期瓣环运动减退,并影响其AFMR程度。Objective To observe the impact of impaired mitral annular motor on atrial functional mitral regurgitation(AFMR)in patients with persistent atrial fibrillation(AF).Methods Forty-four persistent AF patients who would undergo radiofrequency ablation(RFA)were prospectively enrolled.Two-dimensional transthoracic echocardiography and real-time three-dimensional transesophageal echocardiography(RT-3D TEE)parameters obtained 1 day before RFA and 3 months after RFA were compared.AFMR was assessed according to effective regurgitant orifice area(EROA),and the change rates of overall annular area(AA)and presystolic AA were evaluated.The difference of EROA before and after RFA was used to describe the improvement degree of AFMR,which was used as the dependent variable,and the related ultrasonic factors 1 day before RFA that affected the improvement degree of AFMR 3 months after RFA were screened.Results Compared with those before RFA,the left atrium global longitudinal strain and left ventricular ejection fraction increased,while the left atrial diameter,left atrial volume,EROA,anteroposterior diameter of valve ring,annular circumference of valve ring,AA,valve leaflet area and non-planar angle decreased,and both the overall AA change rate and presystolic AA change rate increased(all P<0.05).The change rate of presystolic AA before RFA was an independent impact factor of the improvement degree of AFMR in persistent AF patients 3 months after RFA(P<0.05).Conclusion Impaired mitral annular motor in persistent AF patients mainly manifested as decreased mitral annular motor function in presystolic period,which impacted the degree of AFMR.

关 键 词：心房颤动 超声心动描记术 三维 二尖瓣 

分 类 号：R541.75[医药卫生—心血管疾病] R445.1[医药卫生—内科学]