二维斑点追踪显像评价阵发性房颤患者左心房功能

摘要

目的 应用二维斑点追踪显像(STI)技术评价阵发性房颤(PAF)患者左心房功能变化.方法 分别对30例PAF患者(PAF组)和30名正常人(对照组)进行常规超声心动图检查,测定左心房内径(LAD)、舒张早期二尖瓣跨瓣血流速度(E)、舒张晚期二尖瓣跨瓣血流速度(A)、E/A、肺静脉收缩峰值流速(PVs)、肺静脉舒张峰值流速(PVd)、肺静脉收缩峰值流速/舒张峰值流速(S/D)、心房收缩期流入肺静脉血流流速(PVa),计算左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房收缩前容积(LAVp)、左心房被动射血分数(LAPEF)和左心房主动射血分数(LAAEF)；应用STI技术获取左心房各壁各节段的应变率曲线,分别测量左心室收缩期左心房峰值应变率(SRs)、左心室舒张早期左心房峰值应变率(SRe)和左心室舒张晚期左心房峰值应变率(SRa),计算其平均值(mSRs、mSRe、mSRa).结果 与对照组比较,PAF组LAD、LAVmax、LAVp、LAVmin增大(P＜0.05),LAAEF、LAPEF减低(P＜0.05)；E升高、A减低、E/A升高(P＜0.05),PVs、PVd减低,S/D减低(P＜0.05) ;PAF组左心房各壁各节段SRs、SRe和SRa降低,差异有统计学意义(P＜0.05).PAF组中,SRs与SRe及SRa之间无相关性(P＞0.05),mSRa与LAAEF之间呈正相关(r=0.78,P＜0.01);对照组中,SRs分别与SRe及SRa呈负相关(r分别为-0.347、-0.384,P＜0.05).结论 PAF患者左心房各壁应变率峰值减低,左心房辅泵功能、管道功能和储蓄功能相互代偿作用减弱或消失.%Objective To evaluate left atrial (LA) function in paroxysmal atrial fibrillation (PAF) patients with two-dimensional speckle tracking imaging (STI) technology. Methods Thirty patients with PAF (PAF group) and 30 healthy subjects (control group) were enrolled in this study. The left atrial diameter (LAD), E peak (E) , A peak (A) , E/A, pulmonary venous flow during systole (PVs) , pulmonary venous flow during diastole (PVd) , S/D, maximal reversal flow velocity during atrial contraction (Pva),The LA maximal) minimal and pre-systolic volume (LAVmax, LAVmin and LAVp), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF) were measured and calculated. The strain rate curve was acquired in each LA segment (anterior, posterior, lateral, inferior and septal) with STI. The peak strain rate of systolic, early and late diastolic (SRs, Sre, Sra) of left atrial wall and calculated the average strain rate (mSRs, mSRe, mSRa) were measured. Results Compared to control group, LAD, LAVmax, LAVp, LAVmin increased (P＜0. 05), and LAAEF, LAPEF decreased (P＜0. 05) in PAF groupi E, E/A increased and A, PVs, PVd, S/D decreased in PAF group (P＜0. 05). Compared with control group, SRs, Sre and Sra decreased in each wall of LA in PAF group (P＜0. 05). In control group, there was negative correlation between SRs and Sre, as well as SRs and Sra (r= - 0. 347, -0. 384, both P＜0. 05). In PAF group, no correlation was found among SRs, Sre and Sra (P＞0. 05) , whereas positive correlation between mSRa and LAAEF was detected (r=0. 78, P＜0. 01). Conclusion The strain rate of each wall of LA decreased, the mutual compensatory function of the pump function, conduit function and reservoir function weakened or disappeared in PAF patients.