超声心动图观察血管紧张素Ⅱ拮抗剂对心房颤动患者复律后心房顿抑的影响

Evaluation of the effect of Angiotensin Ⅱ on atrial stunning after cardioversion with echocardiography

目的探讨常规超声心动图及定量组织速度成像（QTVI）技术观察血管紧张素Ⅱ（AngⅡ）拮抗剂对心房颤动患者复律后左房顿抑的作用。方法正常对照组40例；心房颤动患者6（）例，随机分成三组：心房颤动对照组，复律前不另用药；血管紧张素转换酶抑制剂（ACEI）组和血管紧张素受体拮抗剂（ARB）组于复律前7d分别应用培哚普利和缬沙坦。三组患者复律后1d、3d、7d和1个月时分别行超声心动图检查，测量二尖瓣口血流频谱A峰速度（VA）、A峰速度时间积分（VTIA）及二尖瓣环舒张晚期运动速度（Va），计算左房充盈分数（AFF）、左房射血力（AEF）等参数。结果①ACEI组和ARB组患者复律后1d时VA、VTIA、AFF、AEF及Va均明显低于正常对照组，但高于同期心房颤动对照组，差异有统计学意义（P〈0．05），并均于复律后7d恢复正常。②ACEI和ARB组间复律后各阶段的心房功能参数差异无统计学意义（P〉0．05）。结论ACEI和ARB可明显减轻心房颤动患者复律后的左房顿抑，但ACEI与ARB对左房顿抑的减轻作用无明显差别。

Objective To observe the effect of Angiotensin Ⅱ on left atrial stunning after cardioversion with echocardiography. Methods Forty adults without heart disease were as normal contrast group, and a total of 60 atrial fibrillation patients were treated by direct-current shock successfully,and they were divided into three groups at random： control group,angiotensin-converting enzyme inhibitor（ACEI） group and angiotensisn receptor blocker （ARB） group. They all underwent echocardiographic examination 1 day after the restoration of sinus rhythm,then after 3 and 7 days and 1 month. The mitral valve orifice A wave velocity（VA ） ,velocity-time integration（VTIA ） and late diastolic velocity of mitral annulus movement（Va） were recorded and left atrial filling fraction（AFF）,ejection force（AEF） were caculated at the same time. Comparison of ACEI group and ARB group with normal contrast and control group and comparison between ACEI group and ARB group were made respectively. Results ①The left atrial parameters such as VA ,VTIA ,AFF,AEF and Va in ACEI and ARB group were lower than those in normal contrast group 24 hours after cardioversion,but they were higher than those in control group in the same period （ P 〈0.05）,and they all came to normal criteria 7 days after cardioversion. ②There was no significant difference between ACEI group and ARB group（ P 〉0.05）. Conclusions ACEI and ARB could decrease atrial stunning, but there was no obvious difference on lessening atrial stunning between ACEI and ARB.