四维自动左心房定量技术评估阵发性心房颤动患者左心房基质的应用价值  

Application value of four-dimensional automated left atrial quantification in evaluating left atrial substrate in patients with paroxysmal atrial fibrillation

作　　者：张旭倩 仝巧立 王静[1] 张胜男 尹洪宁[1] ZHANG Xu-qian;TONG Qiao-li;WANG Jing;ZHANG Sheng-nan;YIN Hong-ning(Department of Echocardiography,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心脏超声科,河北石家庄050000

出　　处：《河北医科大学学报》2025年第3期254-260,共7页Journal of Hebei Medical University

摘　　要：目的拟应用四维自动左心房定量技术(four-dimensional auto left atrial quantification,4D Auto LAQ)评估阵发性心房颤动患者左心房基质情况。方法本研究纳入河北医科大学第二医院行左心房基质的电压标测及射频消融术的阵发性心房颤动患者59例。根据电压标测结果分为无低电压组(35例)和低电压组(24例),比较2组一般临床资料、常规超声心动图参数、左心房应变等,通过Logistic回归分析得出相关因素,并通过受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)得出预测左心房低电压价值最高的参数及其截断值。结果低电压组平均年龄、CHA2DS2-VASc评分、左心房前后径(left atrial diameter,LAD)、左心房容积指数(left atrial volume index,LAVI)、左心房最大容积(left atrial maximal volume,LAVmax)、左心房最小容积(left atrial minimal volume,LAVmin)、左心房僵硬度(left atrial stiffness,LA stiffness)高于无低电压组,左心房总排空分数(left atrial total emptying fraction,LAEF)、左心房储蓄期长轴应变(left atrial reservoir longitudinal strain,LASr)、左心房管道期长轴应变(left atrial conduit longitudinal strain,LAScd)、左心房收缩期长轴应变(left atrial contraction longitudinal strain,LASct)、左心房储蓄期环形应变(left atrial reservoir circumferential strain,LASr-c)、左心房管道期环形应变(left atrial conduit circumferential strain,LAScd-c)、左心房收缩期环形应变(left atrial contraction circumferential strain,LASct-c)均低于无低电压组(P<0.05)。多因素Logistic回归分析显示校正了性别等因素后,上述指标是左心房有无低电压的影响因素,其中LASr预测价值最高(AUC为0.904,最佳截断值18.50%,敏感度82.9%,特异度83.3%)。结论LASr有助于术前无创评估阵发性心房颤动患者左心房基质情况。Objective To evaluate the left atrial substrate in patients with paroxysmal atrial fibrillation(PAF)using four-dimensional automated left atrial quantification(4D Auto LAQ).Methods A total of 59 patients with PAF who underwent voltage mapping of the left atrial substrate and radiofrequency ablation in the Second Hospital of Hebei Medical University were included in this study.Based on the voltage mapping results,patients were divided into the non-low voltage group(n=35)and the low voltage group(n=24).General clinical data,conventional echocardiogram parameters,left atrial strain and related parameters were compared between the two groups.The relevant factors were obtained by Logistic regression analysis.The parameters with the highest predictive value for left atrial low voltage and its cut-off value were determined by the area under receiver operating characteristic(ROC)area under curve(AUC).Results The mean age,CHA2DS2-VASc score,left atrial diameter(LAD),left atrial volume index(LAVI),left atrial maximal volume(LAVmax),left atrial minimal volume(LAVmin),and left atrial stiffness(LA stiffness)of the low voltage group were higher than those in the non-low voltage group.Left atrial total emptying fraction(LAEF),left atrial reservoir longitudinal strain(LASr),left atrial conduit longitudinal strain(LAScd),left atrial contraction longitudinal strain(LASct),left atrial reservoir circumferential strain(LASr-c),left atrial conduit circumferential strain(LAScd-c)and left atrial contraction circumferential strain(LASct-c)were lower in low voltage group than in the non-low voltage group(P<0.05).Multivariate logistic regression analysis showed that after correcting for factors such as gender,the above indicators were still correlated with the presence or absence of low voltage,and the LASr had the highest predictive value(AUC=0.904,with the optimal cut-off value of 18.50%,sensitivity of 82.9%,and specificity of 83.3%).Conclusion LASr aids in non-invasive preoperative evaluation of left atrial substrate in PAF patients.

关 键 词：心房颤动 左心房基质 四维自动左心房定量技术 电压标测 

分 类 号：R541.75[医药卫生—心血管疾病]