超声斑点追踪技术评价阵发性房颤患者射频消融前后左心房功能变化

摘要

目的：探讨超声斑点追踪成像（STI）技术评价阵发性房颤患者射频消融前后左心房功能变化。方法对28例成功接受环肺静脉消融治疗的阵发性心房颤动患者于术前、术后24 h及术后3个月进行常规超声心动图检查。常规二维超声测定左心房内径（ LAD）、舒张早期跨二尖瓣血流速度（ E）、舒张晚期跨二尖瓣血流速度（ A）。应用STI技术测定左心房各壁应变率曲线，获得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）、左心室舒张晚期左心房峰值应变率（SRa），并计算左心房壁中段峰值应变率的平均值（mSRs、mSRe、mSRa）。应用改良Simpson′s 法测定左心房最大容积（LAVmax）、左心房最小容积（LAVmin）、左心房P容积（LAVp），计算出左心房主动射血分数（LAAEF）及左心房被动射血分数（LAPEF）。结果①28例阵发性房颤患者成功实施环肺静脉消融术，LAD、LAVmax、LAVmin及LAVp术后24 h无明显变化，术后3个月较术前相比明显减小，差异有统计学意义（P＜0．05）。术后24 h LAAEF、LAPEF无明显变化，术后3个月LAAEF较术前明显增加（P＜0．05）。术后24 h二尖瓣舒张晚期A峰峰值较术前降低（P＜0．05），术后3个月较术前明显增加（P＜0．05）。②术后24 h mSRs、mSRe及mSRa与术前相比均降低（P＜0．05），术后3个月mSRs、mSRe恢复至术前水平，mSRa较术前明显改善（P＜0．05）。结论 STI技术可以无创评价左心房功能；成功射频消融术后对左心房功能早期虽然存在不利影响，但随时间推移左心房重构将得到恢复，左心房辅助泵功能明显改善。%Objective To evaluate left atrial function in the patients with paroxysmal atrial fibrillation ( PAF) after catheter ablation with specking -tracking imaging ( STI) echocardiography .Methods Thansthoracic echocardiography were performed on baseline , 24hours, and 3 months after treatment on 28 patients with radiofrequency ablation treatment for PAF.The peak strain rate of systolic, early and late diastolic of left atrial middle segments (mSRs, mSRe,mSRa) were analyzed with STI.The maximal and minimum left atrial volume (LAVmax, LAVmin),left atrial p volume (LAVp), left atrial active ejection fraction ( LAAEF) and the left atrial passive ejection fraction ( LAPEF) were measured using Simpson's method.The flow velocity of early diastolic filling wave ( E) and later filling wave ( A) of mitral annulus were measured . Results There were no significantly difference between pre -operation and 24 hours post ablation in LAD , LAVmax LAVmin and LAVp.3 months post ablation a significant reduction in LAD ,LAVmax, LAVmin and LAVp were observed compared with pre-operation .There were no significantly difference between pre -operation and 24 hours post ablation in LAAEF and LAPEF .3 months post ablation LAAEF increased significantly than that of pre -operation .Compared with pre-operation 24 hours post ablation , the mSRs、mSRe and mSRa decreased significantly , the mSRs、mSRe recov-ered and mSRa significantly improved after 3 months post ablation .The mitral annulus later filling A wave decreased sig-nificantly after 24 hours post ablation , and significantly improved after 3 months post ablation .Conclusions STI can assess the changes of left atrial function noninvasively The function of left atrial will decrease early after Catheter ablation , but with long-time reconstruction , The pump function will improve significantly .