心房颤动复律前后左房结构和功能变化的超声心动图研究

Changs of left atrial structure and function before and after cardioversion in patients with atrial fibrillation by echocardiography

目的应用超声心动图观察心房颤动(简称房颤)患者复律前后左房结构和功能的变化。方法选择房颤患者20例,按心脏复律的方式分为直流电复律组7例,药物复律组13例,分别于复律前、复律后第1天、第3天、第7天、第1个月时应用超声心动图测定左房内径和容积,记录二尖瓣血流频谱A峰流速(VA)、A峰速度时间积分(A-VTI)、心房充盈分数(AFF)和左房射血力(LAEF)。分析左房内径、容积变化与左房收缩功能的关系。应用心房肌超声组织定征技术在左房后壁心肌和心包处测量背向散射积分值(IBS)及背向散射积分周期变异幅度(CVIB)评价心肌组织的声学特征。结果房颤时所有患者均存在左房扩大,而恢复窦性心律后直流电复律组和药物复律组的左房上下径均显著降低(P<0.05或0.01)。恢复窦性心律后第1天、第3天直流电复律与药物复律组比较,左房最大和最小容积显著增大(P<0.05或0.01),VA、A-VTI、AFF和LAEF明显降低。房颤时左房心肌标化IBS较健康对照组增大,而CVIB则降低(P均<0.01),直流电复律组恢复窦性心律后第1天、第3天左房心肌标化IBS及CVIB与房颤时比较无差异(P>0.05),而药物复律组左房IBS%与房颤时和直流电复律组比较显著降低,CVIB则显著增大。恢复窦性心律后第7天、第1个月时,两组左房IBS%与房颤时比较均显著降低,CVIB显著增大(P均<0.01),两组无差异。结论两种复律方式成功复律后随时间推移均可改善房颤患者的左房结构重构和功能。

Objective To observe changes of left atrial structure and function before and after cardioversion in patients with atrial fibrillation（AF） by echocardiography. Methods The initial study population included 20 patients with AF. According to cardioversion patterns,the patients were divided into cardioversion with direct-current shock（7 patients）and drugs （13 patients）. Eehocardiographie parameters including left atrial（ LA ）size and volume, peak A velocity（ Vn ） , velocity time integral of A-wave（ A-VTI）, velocity time integral of E-wave（ E-VTI）, atrial filling fraction（AFF） ,left atrial ejection force（LAEF） were measured before and 1,3,7 days and 1 month after cardioversion. The relations betweens LA contractility function and changes of size and volume were analyzed . The posterior wall of left atrial and the correspondence pericardium were selected for detecting integrated baekseateer（IBS） and cyclic variation of IBS by ultrasonic tissue characteristic technology. Results LA dilated in all the patients during AF and the superior-inferior diamensions of LA decreased after cardioversion. Left atrial maximal volume（LAVmax） and left atrial minimal volume（LAVmin） increased while VA, A-VTI, AFF,LAEF decreased 1,3 days after direct-current shock as compared with patients treated with drugs. IBS （%） showed an increase, while CVIB showed a decrease during AF, IBS（ % ） and CVIB had no significant difference at 1,3days after direct-current shock. IBS（% ） showed a decrease ,while CVIB showed an increasel ,3 days after drug group as compared with direct-current shock group and AF. IBS（% ） showed a decrease,while CVIB showed an increase 7 days and 1 month after cardioversion,and had no difference between two group. Conclusions Both cardioversion ways can improve atrial structure and function remodeling along with the time. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2007,21 （ 3 ） ：222 - 226 ]