经食管脉冲组织多普勒评价阵发性房颤患者的左心耳功能

Left atrial appendage function in patients with paroxysmal atrial fibrillation:a transesophageal pulse tissue Doppler study

目的:利用脉冲组织多普勒评价阵发性房颤患者左心耳功能。方法:176例阵发性房颤患者,经食管超声发现左心耳血栓或高凝状态26例(Ⅰ组),无血栓150例(Ⅱ组);正常心律对照者30例(Ⅲ组);经胸超声分别测量左房前后径、左室射血分数、左房射血分数、E/E’;经食管超声测量左心耳射血分数、左心耳充盈血流峰速和排空血流峰速,脉冲组织多普勒测量左心耳壁收缩期峰速和舒张期峰速。结果:Ⅰ组左心耳充盈血流峰速和排空血流峰速较Ⅱ组和Ⅲ组减小(P<0.05);Ⅰ组左房射血分数及左心耳射血分数低于Ⅰ组和Ⅲ组(P<0.05);脉冲组织多普勒测量左心耳侧壁收缩期和舒张期速度Ⅰ组小于Ⅱ组和Ⅲ组(P<0.05);Ⅰ组左房前后径、E/E’较Ⅱ组和Ⅲ组增大(P<0.05);Ⅱ、Ⅲ组各参数无明显差别(P>0.05)。结论:脉冲组织多普勒可用来评价左心耳功能,预测左心耳血栓形成风险。

Objective： The left atrial appendage （LAA） function was evaluated in patients with paroxysmal atrial fibrillation by pulse tissue Doppler echocardiographic examinations. Methods： One hundred and seventy-six patients with paroxysmal atrial fibrillation were enrolled. Twenty-six patients having LAA thrombus or spontaneous echo contrast were selected as group Ⅰ and other 150 patients formed group Ⅱ. Thirty healthy subjects served as the control group（group Ⅲ）. Transthoracie echocardiographic parameters included left atrial diameter （LAd）, left ventricular ejection fraction （LVEF）, left atrial ejection fraction （LAEF） and E/E＇. In order to determine the LAA function, LAA peak filling flow velocity（LAAPFV）, LAA peak emptying flow velocity（LAAPEV） and percentage of LAA area change（LAAAC） were measured. Pulse tissue Doppler of LAA wall parameters included LAA late systolic wave （LSW） and late diastolic wave （LDW）. Results： Compared to group Ⅱ and Ⅲ, LAAPFV, LAAPEV were lower in group Ⅰ （P〈0.05）; LAAAC and LAEF was also reduced in group Ⅰ （P〈0.05）; Pulse tissue Doppler LSW and LDW were found to be quite reduced in group Ⅰ （P〈0.05）; LAd and E/E＇ increased in group Ⅰ （P〈0.05）. The study parameters were statistically similar in patients between group Ⅱ and Ⅲ（P〉0.05）. Conclusion： Pulse tissue Doppler may be a complement to flow velocities in evaluating LAA function for risk assessment of thromboembolism.