实时三维超声联合斑点追踪超声评价阵发性房颤患者射频消融术后左室同步性及收缩功能

Assessment of left ventricular synchronization and systolic function in patients with paroxysmal atrial fibrillation after circumferential pulmonary vein isolation by real-time three-dimensional and speckle tracking echocardiography

目的 探讨实时三维超声心动图（RT-3DE）联合斑点追踪超声（STE）无创评价阵发性房颤（PAF）患者射频消融手术前后左心室同步性及收缩功能变化.方法 40例接受环肺静脉射频消融治疗的PAF患者术前、术后3个月窦性心律下进行RT-3DE及STE检测.Qlab7.0脱机分析3D-Advanced软件得到左室17节段时间-容积曲线,将左室特定节段到达最小收缩容积（Tmsv）时间的标准差校正值和达到最小收缩容积（Tmsv）最大时间差的校正值（Tmsv 16-SD％、Tmsv 12-SD％、Tmsv 6-SD％、Tmsv 16-Dif％、Tmsv 12-Dif％、Tmsv 6-Dif％）作为评价左室收缩同步性的指标.Qlab7.0脱机分析TMQA软件得到左室整体纵向收缩期峰值应变（GlS）、径向收缩期峰值应变（GrS）和圆周收缩期峰值应变（GcS）.结果 40例PAF患者术后3个月有4例复发,36例患者维持窦性心律（PAF组）.PAF组左室整体射血分数（GLVEF）与正常对照组相比未见统计学差异[（57.4±6.6）％比（59.3土7.7）％,P＞0.05].维持窦律者纳入术后研究,PAF组术前Tmsv 16-SD％、Tmsv 12-SD％、Tmsv 6-SD％、Tmsv 16-Dif％、Tmsv 12-Dif％、Tmsv 6-Dif％与对照组比较均显著延长（P均＜0.05）.术后3个月上述指标较术前缩短,差异有统计学意义（P＜0.05）.与正常对照组相比,PAF组GlS、GrS、GcS明显降低[（-12.61±5.46）％比（-23.42土7.59）％,（-18.71±9.74）％比（-33.22±8.67）％,（-15.43±7.11）％比（-25.49±9.63）％,P＜0.05];术后3个月与术前相比,上述指标明显增加[（-16.40±6.55）％比（-12.61±5.46）％,（-25.37±8.36）％比（-18.71±9.74）％,（-18.74±7.56）％比（-15.43±7.11）％,P＜0.05].结论 RT-3DE联合STE可评价PAF患者环肺静脉射频消融术后左室协调性及收缩功能.

Objective To assess the change of myocardial synchrony and systolic function in patients with paroxysmal atrial fibrillation （PAF） after circumferential pulmonary vein isolation ablation by compound real-time three-dimensional echocardiography （RT-3DE） and speckle tracking echocardiography （STE）. Methods 40 pa- tients with PAF and 30 age and sex matched normal controls underwent examinations with 2D and Full volume RT-3DE at baseline and 3 month after circumferential pulmonary vein isolation ablation. The global left ventricle ejection fraction（GLVEF ） and 17 segmental volume-time curves were obtained wil h QLab 7.0 off-line software. The difference（Dif） and stand deviation（SD） of the time to.the point with minimal systolic volume（Tmsv） in 16, 12, and 6 segments were measured and adjusted by interval R-R interval（Tmsv SD%, Tmsv Dif% ）. Global Longitudi- nal peak systolic strain （G1S）, Global radial peak systolic strain （GrS） and Global circumferential peak systolic strain （GcS） were analyzed with STE methods. Results There were no significantly difference between PAF group and normal control group in GLVEF[ （57.4±6.6）% vs. （59.3±7.7）%, P〉0.05 ]. 3 month after ablation 36 patients with PAF restored and maintained sinus rhythm and 4 had recurrence. Compared with control group, the Tmsv 16- SD%, Tmsv 16-Dif%, Tmsv 12-SD%, Tmsv 12-Dif%, Tmsv 6-SD%, and Tmsv 6-Dif% were increased signif- icantly （P〈0.05）. 3 month after ablation, the Tmsv 16-SD%, Tmsv 16-Dif%, Tmsv 12-SD%, Tmsv 12-Dif%, Tmsv 6-SD% and Tmsv 6-Dif% were significantly decreased compared with pre-operation （P〈0.05）. Compared with normal control, the G1S, GrS, GcS of PAF decreased significantly [（-12.61±5.46）% vs. （-23.42±7.59）%, （-18.71±9.74）% vs. （-33.22±8.67）%, （-15.43±7.11）% vs. （-25.49±9.63）%, P〈0.05], and 3 month after ablation, G1S, GrS, GcS of PAF increased significantly compared with pre-operation [（-16.40-±6.55）% vs. （-12.61-±5.46）%, （-25.37-±8.36）% vs. （-18.71±9.74）%, （-18.74±7.56）% vs. （-15.43±7.11）%, P〈0.05]. Conclusion Systolic synchrony and systolic function are impaired in PAF patients with normal GLVEF. After cir- cumferential pulmonary vein isolation ablation the LV systolic asynchrony and systolic function of PAF patients are improved. Circumferential pulmonary vein isolation ablation is a useful method for assessment LV synchrony and systolic function in PAF patients before and after circumferential pulmonary vein isolation ablation.