经食管超声评估非瓣膜性心房颤动患者左心耳血流动力学改变对左心耳血栓形成的预测价值

摘要

目的 应用经食管超声心动图(TEE)评价非瓣膜性心房颤动(以下简称房颤)患者左心耳血流动力学变化状况,探讨其预测左心耳血栓形成的价值.方法 选取我院房颤组138例和对照组30例,均接受TEE检查.分别从0°、45°、90°、135°不同角度观察两组左心耳二维图像,获取左心耳血流频谱及组织速度成像图像;测量左心耳射血分数(LAAEF)、最大容积(LAAVmax)、血流峰值排空速度(LAA-EV)和峰值充盈速度(LAA-FV)、血流平均排空速度(LAA-AEV)和平均充盈速度(LAA-AFV),以及左心耳各壁收缩期峰值速度(LAA-SV)和舒张期峰值速度(LAA-DV).并对两组上述指标进行比较.结果 房颤组与对照组比较,LAA-EV、LAA-AEV、LAA-FV、LAA-AFV及LAAEF均减低,LAAVmax增高,差异均有统计学意义(均P<0.05).房颤组138例患者中,左心耳存在血栓者15例,无血栓者123例,对照组、房颤组无血栓者及合并血栓者LAA-AEV、LAA-AFV、LAAEF及左心耳各壁LAA-SV和LAA-DV依次减低,差异均有统计学意义(均P<0.05).LAA-AFV判断发生左心耳血栓的截断值为27.5 cm/s,特异性及敏感性分别为73.3%、96.7%;LAA-AEV判断发生左心耳血栓的截断值为33.0 cm/s,特异性及敏感性分别为80.0%、86.7%.结论 TEE能有效评价左心耳血流动力学状态及其功能.房颤患者左心耳收缩、舒张功能减低,左心耳血栓形成时减低更甚.LAA-AFV和LAA-AEV可以预测非瓣膜性房颤患者左心耳血栓形成的风险.%Objective To explore the value of transesophageal echocardiography(TEE)in evaluating left atrial appendage (LAA) hemodynamics and predicting LAA thrombus in patients with nonvalvular atrial fibrillation.Methods One hundred and thirty-eight atrial fibrillation patients and 30 controls were enrolled in this study.At the 2D-TEE mid-esophageal views,LAA flow spectra and tissue velocity imaging of 0°,45°,90° and 135° were obtained respectively.LAA ejection fraction(LAAEF),LAA maximal volume(LAAVmax),LAA filling peak flow velocity(LAA-FV),LAA emptying peak flow velocity(LAA-EV),LAA average filling flow velocity(LAA-AFV),LAA average emptying flow velocity(LAA-AEV),LAA walls systolic peak velocity (LAA-SV) and diastolic peak velocity(LAA-DV) were measured . The above indicators were compared in two groups . Results Compared to the control group,LAA-EV,LAA-AEV,LAA-FV,LAA-AFV and LAAEF were lower and LAAVmax were higher in atrial fibrillation group(all P<0 . 05). Among 138 atrial fibrillation patients , there were 15 patients with LAA thrombus,and 123 patients without thrombus.LAA-AEV,LAA-AFV,LAAEF,LAA-SV and LAA-DV gradually reduced among controls,patients without thrombus and with thrombus.The cut-off values of LAA-AFV and LAA-AEV in diagnosis of LAAthrombus were 27.5 cm/s and 33.0 cm/s respectively,specificity were 73.3% and 80.0%,sensitivity were 96.7% and 86.7%, respectively.Conclusion TEE can effectively reflect LAA hemodynamics and function.The LAA systolic and diastolic function of nonvalvular atrial fibrillation patients are lower,and even worse in those with thrombus.LAA-AEV and LAA-AFV are good parameters which can provide more references for predicting LAA thrombus in nonvalvular atrial fibrillation patients.