二维及实时三维超声心动图在评价老年持续性心房颤动患者心脏结构和心室功能中的应用

Evaluation of cardiac structure and function in elderly patients with persistent atrial fibrillation by two-dimensional and real-time three-dimensional echocardiography

目的应用二维及实时三维超声心动图技术评价老年持续性心房颤动患者的心脏结构和心室功能。方法选取2015年1月至2016年12月于大连医科大学附属第二医院就诊的持续性心房颤动病史大于15年的老年患者50例作为病例组,同期健康体检老年人50名作为对照组。采用常规超声测量两组左心房舒张末期面积(LAA)、右心房舒张末期面积(RAA)、左心室舒张末期内径(LVD_d)、左心室收缩末期内径(LVDs)、室间隔厚度(IVST_d)、左心室后壁厚度(LVPW_d)、二尖瓣反流(MR)、右心室舒张末期前后径(RVD_d)、三尖瓣反流(TR)、下腔静脉塌陷率(ΔIVC)。应用频谱多普勒测定二、三尖瓣口舒张期血流频谱,组织多普勒测定二、三尖瓣环运动频谱,计算左、右心室舒张功能指标E/E';实时三维超声心动图分别测量左右心室收缩末期容积(ESV)、左右心室舒张末期容积(EDV)、左右心室射血分数(EF)。结果常规二维超声测量结果:与对照组比较,病例组LVD_d、LVDs、IVST_d和LVPW_d均无明显变化(均为P>0.05);LAA、MR、RAA、RVD_d、TR和E/E'升高,ΔIVC减低,差异均有统计学意义(P<0.05或P<0.01)。三维超声参数测量结果:与对照组比较,病例组RVEDV、RVESV增大,RVEF减低,差异均有统计学意义(均为P<0.05),LVEDV、LVESV有增大趋势,LVEF有减低趋势,但差异无统计学意义(均为P>0.05)。结论实时三维超声心动图不依赖于心室的几何形状,能够准确直观测量左右心室的容积和射血分数。长期心室律控制不佳的老年心房颤动患者心脏结构及功能发生变化,双心房及右心室增大,心功能减低,尤其右心功能减低较左心功能减低明显,三尖瓣反流较二尖瓣反流明显。

Objective To evaluate the cardiac structure and ventricular function in elderly patients with persistent atrial fibrillation（ PAF） by two-dimensional and real time three-dimensional echocardiography.Methods From January 2015 to December 2016,50 patients with PAF more than 15 years in the Second Affiliated Hospital of Dalian Medical University were enrolled as experimental group; 50 healthy subjects in the same period were selected as control group. The parameters of the conventional two-dimensional echocardiography were obtained respectively for experimental group and control group： the area of left atrial end-diastolic（ LAA）; the area of right atrial end-diastolic（ RAA）; left ventricular end-diastolic dimension （ LVD_d）; left ventricular end-systolic dimension（ LVDs）; end-diastolic thickness of ventricular septum（ IVST_d）; end-diastolic thickness of LV posterior wall（ LVPW_d）; mitral regurgitation（ MR）; right ventricular end-diastolic dimension（ RVD_d）; tricuspid regurgitation（ TR）; the rate change of inferior vena cava（ ΔIVC）;diastolic flow velocity of mitral valve diastolic and tricuspid valve were measured by spectral Doppler,and diastolic velocity of mitral and tricuspid annular plane by tissue Doppler imaging,then E/E ＇ were calculated. The parameters of the three-dimensional echocardiography parameters were obtained for experimental group and control group： end-systolic volume（ ESV）; end-diastolic volume（ EDV）; ejection fractions of Simpson（ EF）. Results Conventional parameters： there were no significant differences between experimental group and control group of LVD_d,LVDs,IVST_dand LVPWd（ all P〈0. 05）; The LAA,MR,RAA,RVD_d,E/E＇,TR of experimental group were significantly higher than those in the control group（ all P〈0. 05）,The ΔIVC of experimental group was decreased significantly than those in the control group（ P〈0. 05 or P〈0. 01）. Three-dimensional parameters： the RVEDV,RVESV were significantly higher and RT-RVEF significantly lower in the experimental group than in the control group（ all P〈0. 05）. LVEDV,LVESV were higher than control groups,and LVEF was lower than control groups,but without statistical significance（ all P〉0. 05）. Conclusions Real-time Three-Dimensional echocardiography is independent of the ventricular geometry and can accurately evaluate left ventricular volume and ejection fraction. In elderly patients with atrial fibrillation and long-term poorly controlled ventricular rate,double atrium and right ventricle are enlarged and heart function,especially right ventricular function decreased.