二维斑点追踪成像评估经皮左心耳封堵术后短期对左房功能的影响

Evaluation of short-term left atrial function after percutaneous atrial appendage closure by echocardiography

目的应用二维斑点追踪成像(2D-STI)评估行经皮左心耳封堵(LAAC)术患者左房各壁应变的变化,探讨LAAC术对左房功能的影响。方法选取我院行LAAC术的心房颤动患者63例(病例组)和健康成人45例(对照组),应用常规经胸超声心动图获取病例组LAAC术前1 d、术后45 d和对照组连续5个心动周期动态图像并存储,测量左房前壁、后壁、侧壁、下壁、间隔壁及房顶部峰值应变,同时通过左房容积变化计算左房功能指数;应用经食管超声心动图获取两组肺静脉血流频谱,比较上述参数的变化。结果与对照组比较,病例组LAAC术前和术后的左房各壁峰值应变均明显减低(均P<0.05);病例组手术前后左房各壁峰值应变比较,差异均无统计学意义。与对照组比较,病例组LAAC术前和术后左房功能指数均明显减低(均P<0.05);病例组术前和术后左房功能指数、肺静脉血流频谱比较,差异均无统计学意义。结论应用2D-STI能有效评估LAAC术后短期内对患者左房功能的影响,可为临床用药方案提供客观依据。

Objective To evaluate the changes of left atrial(LA)wall strain before and after the left atrial appendage (LAAC)closure,and to investigate the short-term effect of LAAC occlusion on left atrial function. Methods Sixty-three patients with atrial fibrillation underwent LAAC closure in our hospital(case group)and 45 healthy adults(control group) were selected.Routine transthoracic echocardiography was used to obtain and store dynamic images of 5 consecutive cardiac cycles befored 1d and 45d after LAAC closure in the two groups.Left atrial wall strain parameters were measured,including anterior wall,posterior wall,lateral wall,inferior wall,partition wall and roof. In the meantime,the left atrial function index was calculated by the left atrial volume changes. Peak velocity of pulmonary vein flow and evaluation of closure were acquired by transesophageal echocardiography. Results Compared with the control group,the peak strain of the left atrial wall before and after LAAC closure were significantly reduced in the case group(all P<0.05).There were no significant difference in the peak strain of left atrial wall before and after LAAC closure in the case group.Compared with the control group,the left atrial function index before and after LAAC closure were significantly reduced in the case group(all P<0.05). There were no significant difference in peak velocity of pulmonary vein flow before and after LAAC closure.Conclusion 2D-STI can effectively evaluate the short-term effect of LAAC closure on left atrial function,which provide an objective basis for clinical drug regimen.