二维斑点追踪显像技术评价阵发性心房颤动患者左心房功能和同步性的研究

Evaluation of the function and synchronization of left atrial in patients with paroxysmal atrial fibrillation by two dimensional speckle tracking imaging

目的应用二维斑点追踪显像（2D-STI）技术定量评价阵发性心房颤动（PAF）患者左房应变特征，并对其同步性作初步研究。方法应用2D-STI对30例健康受试者和35例PAF患者（其中PAF发作间歇期19例为PAF1组，发作期16例为PAP2组）左房的前壁、下壁、侧壁、后壁和房间隔5个房壁进行应变时间曲线分析，获取收缩期、舒张早期和舒张晚期的各房壁平均峰值应变速度（Vs、Ve和Va）、峰值应变（Ss、Se和Sa）和峰值应变率（SRs、SRe和SRa），通过达峰值应变时间计算左房各时期的同步性参数（Ts-SD、Te-SD和Ta-SD）。并分析同步性参数与应变率等指标的相关性。结果①对照组、PAF1组和PAF2组在年龄、心率、E／A、室间隔舒张末期厚度（IVS）、左室舒张末期内径（LVEDD）、左室射血分数（LVEF）等指标差异无统计学意义，但PAF1组和PAF2组左房前后径（LAD）较对照组增大，二尖瓣E峰减速时间（DT）缩短（P〈0．05）。②PAF1组和PAF2组应变速度减慢，应变减少，应变率降低，差异有统计学意义（P〈O．05）。SRa在PAFl组和对照组间差异无统计学意义（P〉0．05）。③Ts-SD和Te-SD在三组间比较差异具有统计学意义（P〈0．05），且PAF2组更不同步；Ta-SD在PAF1组和对照组间差异有统计学意义（P〈0．05）。④Ta-SD与SRa有较强的正相关关系（r=0．61，P〈0．01）。结论PAF发作间歇期左房储血功能和管道功能降低，辅泵功能部分恢复，但存在运动不同步，PAF发作期辅泵功能消失，同步程度更差。2D-STI可以较好地评价左房功能和同步性。

Objective To evaluate the function and synchronization in patients with paroxysmal atrial fibrillation（PAF） by two dimensional speckle tracking imaging（2D-STI） measuring the strain of left atrial. Methods Thirty healthy controls and thirty-five patients with PAF were studied. The PAFs were divided into group PAF1 during the diapause and group PAF2 during the stage of attack. From the strain-time curve of 2D-STI workstation,the peak velocity（Vs, Ve and Va）, the peak amplitude of longitudinal strain（Ss, Se and Sa） and strain rate （SRs,SRe and SRa） were acquired in the course of systole, the early and the late diastole respectively. The synchronization of left atrial （Ts-SD,Te-SD and Ta-SD） could be gotten from the time to the peak strain. The correlation were analysed between the synchronization indices and the strain rate parameters. Results ①No significant differences were found at the age, heart rate, E/A, IVS, LVEDD and LVEF. Compared with the control group, the LAD increased and DT decreased in PAF1 and PAF2 groups （P d0.05）. ②The peak velocity were slower, the peak strain were shorter and the peak strain rate were lessened in the PAFs than the controls（ P 〈0.05）,except the SRa（ P 〉0.05）. ③The Ts-SD and Te-SD were much more different during the three groups（ P〈0.05）, the PAF2 showed fewer synchronization; the Ta-SD was higher in the PAF1 than the controls（ P d0.05）. ④The Ta-SD had a positive correlation with SRa（ r = 0.61, P 〈0. 01）. Conclusions The reservoir and conduit function of left atrial are impaired in PAFs during the diapause, the booster pump could recover partially, however, there are dyssynchronization. The booster pump function disappear during the stage of attack and there are worse synchronization. 2D-STImay paly important roles in the assessment of function and synchronization of left atrial.