孤立性心房颤动患者左房应变率与房内传导时间关系的研究

Study on the relationship between left atrial strain rate and total atrial conduction time for lone atrial fibrillation

目的研究孤立性心房颤动(LAF)患者的左房心肌应变特点及总的心房传导时间(PA-TDI)改变,探讨二者之间的关系。方法入选53例LAF患者作为LAF组,选取50名健康志愿者作为对照组。测量两组的常规超声心动图指标,应用组织多普勒方法测定PA-TDI间期,应用二维斑点追踪成像(2D-STE)技术对左房心房肌的应变率进行分析。结果与对照组比较,LAF组左房心肌的左室收缩期应变率(SRs)和左房收缩期应变率(SRa)明显降低(均为P<0.01)。对照组左房心肌SRs与PA-TDI间期呈负相关(r=-0.436,P=0.002),左房心肌SRa与PA-TDI间期呈正相关(r=0.377,P=0.01)。LAF组左房心肌SRs与PA-TDI间期呈负相关(r=-0.468,P=0.001),左房心肌SRa与PA-TDI间期呈正相关(r=0.390,P=0.004)。Logistic多元回归分析显示,PA-TDI可独立预测LAF发生(OR:1.28,95%CI:1.02~1.54,P=0.005)。结论 LAF患者左房应变率降低,PA-TDI间期延长;反映左房结构的应变率指标与反映左房电重构的PA-TDI间期呈正相关;PA-TDI是LAF发生的独立预测因子。

Objective To investigate the characteristics of left atrium（LA） strain and the change of total atrial conduction time （PA-TDI）in patients with lone atrial fibrillation（ LAF）, and to assess relationships between LA strain rate and total atrial conduction time（ TACT）measured by tissue Doppler imaging （TDI）. Methods Fifty-three LAF patients （LAF group）and 50 healthy volunteers （control group）were enrolled into this study. Transthoracic echocardiography was done on both groups. PA-TDI was measured by TDI while LA segmental strain rate（SR） was assessed by two-dimensional speckle-tracking echocardiography（2D-STE）. Results Compared with the control group, LA myocardial strain rate during LV systole（SRs） and strain rate during atrial contraction （SRa）were significantly decreased in the LAF group（ P 〈 0. 01 ）. In the control group, LA myocardial SRs was negatively correlated with PA-TDI （ r = - 0. 436, P = 0. 002 ）. LA myocardial SRa was positively correlated with PA-TD1 （ r = 0. 377, P = 0. 01 ）. In the LAF group, LA myocardial SRs was also negatively correlated with PA-TDI（ r = -0. 468 ,P = O. 001 ） , and SRa was positively correlated with PA- TDI （r = 0. 390, P = 0. 004）. Muhivariate logistic regression suggested PA-TDI was an independent predictor for LAF （ OR ： 1. 28,95 % CI ： 1.02 - 1.54, P = 0. 005 ）. Conclusions LASR is decreased and PA-TDI is prolonged in LAF patients. SR, which is a parameter for LA structural, and PA-TDI, which is a factor for LA electrical remodeling, is positively correlated. Prolonged PA-TDI may be an independent predictor for LAF occurrence.