经食管实时三维超声心动图评价房性心律失常对二尖瓣结构和功能的影响

Evaluation of the effect of atrial arrhythmia on mitral valve structure and function by real-time three-dimensional transesophageal echocardiography

目的通过经食管实时三维超声心动图(RT-3D-TEE)技术对房性心律失常患者的二尖瓣进行定量分析,以此评价二尖瓣结构和功能的影响因素。方法入选46例房性心律失常拟行射频消融术的患者,另选取20例窦性心律者为正常对照组,两组均行经胸超声心动图(TTE)和RT-3D-TEE检查,获取左房前后径(Lad)、左室射血分数(LVEF)、瓣环前外侧至后内侧直径(DAlPm)、瓣环前后径(DAP)、瓣环高度(H)、瓣环周长(C3D)、瓣环投影面积(A2D)、主动脉瓣口与二尖瓣环平面夹角(NPA),并计算对合面积及对合指数。比较两组间各参数的差异,并分析各参数与对合指数的相关性。同时,采用逐步线性回归或二项Logistic回归分析患者各临床因素与二尖瓣对合指数的相关性和二尖瓣返流的相关性。结果与窦性心律组相比,房性心律失常组患者的Lad、DAlPm、DAP、C3D、A2D、H均显著增加(P<0.05),对合指数显著降低(P<0.05),而对合面积、LVEF、NPA差异无统计学意义(P>0.05)。将入选的房性心律失常患者分为阵发性房颤、持续性房颤、房扑、混合型房性心律失常4个亚组,通过单因素方差分析,发现各组间对合指数、Lad、C3D及LVEF差异均无统计学意义。Logistic回归分析显示女性是对合指数的危险因素(OR=5.409;95%CI:1.409~20.768;P=0.014);房性心律失常(OR=7.062;95%CI:1.651~30.206;P=0.008)以及对合指数差(OR=12.973;95%CI:3.452~48.762;P<0.001)可导致二尖瓣返流。结论房性心律失常可显著影响二尖瓣的结构和功能。

Objective To evaluate the factors influencing the structure and function of mitral valve through quantitative analysis of characteristics of mitral valve in the patients with atrial arrhythmia by real-time three-dimensional transesophageal echocardiography(RT-3 D-TEE) technology.Methods 46 patients with atrial arrhythmia prepared to undergo surgery of radiofrequency ablation were selected in the case group, and another 20 patients with sinus rhythm were selected as the normal control group. Transthoracic echocardiography(TTE) and RT-3 D-TEE examinations were performed in both groups to get the parameters of left atrium anterior-posterior diameter(Lad), left ventricular ejection fraction(LVEF), anterolateral to posteromedial diameter(DAlPm), anterior to posteriordiameter( DAP),height( H),three dimensional circumference( C3 D),two dimensional area( A2 D) and nonplanarity angle( NPA),and mitral valve coaptation area and mitral valve coaptation index were measured simultaneously. The differences of the parameters between the two groups were compared and the correlation between these parameters and mitral valve coaptation index was analyzed. Meanwhile,stepwise linear regression or binomial Logistic regression was used to analyze the correlation between clinical factors in patients and mitral valve coaptation index,and mitral regurgitation. Results Compared with the sinus rhythm group,Lad,DAl Pm,DAP,C3 D,A2 D and H of patients in the atrial arrhythmia group increased obviously( P < 0. 05),mitral valve coaptation index decreased significantly( P < 0. 05),and mitral valve coaptation area,LVEF and NPA had no statistical difference( P> 0. 05). The selected patients with atrial arrhythmias were divided into 4 subgroups: paroxysmal atrial fibrillation,persistent atrial fibrillation,atrial flutter and mixed atrial arrhythmias. There was no significant difference in mitral valve coaptation index,Lad,C3 D and LVEF among these groups by one-way analysis of variance. Logistic regression analysis showed that female was the risk factors for inferior mitral valve coaptation index( OR = 5. 409,95% CI: 1. 409 ~ 20. 768,P = 0. 014) and that atrial arrhythmia( OR = 7.062,95% CI: 1.651 ~ 30. 206,P =0. 008) and lower mitral valve coaptation index(OR=12. 973,95% CI: 3. 452 ~ 48. 762,P<0.001) could lead to mitral regurgitation. Conclusion Atrial arrhythmia can affect the structure and function of mitral valve significantly.