经胸超声心动图通过左心房参数评估房颤患者左房淤血状态

Trans-Thoracic Echocardiographic Assessment of Left Atrial Blood St a sis in Atrial Fibrillation Patients by Clinical Parameters of Left Atrial Remodeling

目的通过经胸超声心动图(Trans-Thoracil Echocardiography,TTE)检测阵发性房颤(Atrial Fibrillation,AF)患者相关参数来评估患者左心耳血流速度(Left Atrial Appendage Flow Velocity,LAA-FV)。方法研究对象为90例非瓣膜阵发性房颤患者,在TTE和经食管超声心动图(TEE)检测期间为窦性心律,评估所有患者超声心动图和临床相关参数。结果 LAA-FV(61±23)cm/s和心电图上P波与TTE上二尖瓣血流A波起始时间间隔(PA-TMF,相关系数:-0.33;P<0.001)、左心房内径(LAD,相关系数:-0.32;P<0.001)、组织多普勒超声室间隔a’速度(TDI,相关系数:0.36;P<0.001)、E/e’比值(相关系数:-0.27,P<0.001)、二尖瓣血流E峰速度(相关系数:-0.21,P=0.007)、二尖瓣血流E/A比值(相关系数:-0.17,P=0.04)、CHA2DS2-VASc评分(相关系数:-0.14,P=0.03)和血浆B型钠尿肽(BNP)水平(-0.33,P=0.003)密切相关。多因素分析显示,PA-TMF(标准化回归系数:-0.16;P=0.04)、a’速度(标准化回归系数:0.25,P=0.005)和LAD(标准化回归系数:-0.21;P=0.02)是LAA-FV独立预测因子(多重相关系数:0.43;P<0.001)。结论心房重构相关参数,如降低的a’速度、增加的LAD及PA-TMF期间窦性心律可以预测阵发性AF患者左心房淤血状况。

Objective To estimate the left atrial appendage flow velocity (LAA-FV) with clinical parameters, which were noninvasively detected in patients with paroxysmal atrial fibrillation (AF) via trans-thoracic echocardiography (TTE). Methods Trans-esophageal echocardiography (TEE) and TTE examinations were simultaneously performed in 90 cases of patients with non-valvular paroxysmal AFduring the period of showing sinus rhythm, thereby to assess the obtained echocardiography and clinical parameters. Results LAA-FV (61±23) cm/s was significantly correlated with the time interval betweenthe initiation of P-wave on electrocardiogram (ECG) and that of A-wave of transmitral flow on TTE (PATMF,r=?0.33, P<0.001), left atrial diameter (LAD, r=?0.32, P<0.001), ventricular septal a’ velocity viatissue Doppler imaging (TDI, r=0.36, P<0.001), E/e’ratio (r=?0.27, P<0.001), E velocity of transmitralflow (r=?0.21, P=0.007), E/A ratio of transmitral flow (r=?0.17, P=0.04), CHA2DS2-VASc score(r=?0.14, P=0.03) and plasma B-type natriuretic peptide (BNP) level (r=?0.33, P=0.003). Multivariateanalysis revealed that PA-TMF (standardized regression coefficient γ=?0.16, P=0.04), a’velocity(γ=0.25, P=0.005) and LAD (γ=?0.21, P=0.02) were independent predictors of LAA-FV (multiple correlation coefficient R=0.43; P<0.001). Conclusion Clinical parameters of atrial remodeling, such as decreased a’velocity, increased LAD and PA-TMF under sinus rhythm, could be regarded as useful predictors of left atrial blood stasis in patients with non-valvular paroxysmal AF.