三维超声心动图及斑点追踪成像评价左心房不同构型阵发性房颤患者左心房功能的临床研究

Three-dimensional echocardiography and speckle tracking imaging in evaluating left atrial function in patients with paroxysmal atrial fibrillation with different configurations of left atrium

目的应用实时三维超声心动图(3D-RTE)及二维斑点追踪成像(2D-STI)评价左心房不同构型的阵发性房颤患者(PAF)左心房结构和功能。方法入选2017年1月至2018年12月于解放军总医院第七医学中心收治的阵发性房颤患者98例。根据二维超声左心房容积指数(LAVI-2D)将房颤患者分为左心房容积正常组(LAN组,LAVI<34 ml/m^2,50例)和左心房容积扩大组(LAE组,LAVI≥34 ml/m^2,48例)。选择同期38例临床资料匹配者为对照组。实时三维超声心动图测定左心房最大容积(LAVmax),左心房最小容积(LAVmin),左心房容积指数(LAVI-3D)和左心房总排空分数(LATEF)。斑点追踪显像获取左心房纵向时间-应变曲线,记录收缩期平均应变(SSL)和各时相平均应变率(mSRs、mSRe、mSRa)。结果PAF患者LAVI平均水平高于对照组,且LAE组LAVI水平高于LAN组,LAVI-3D测量值较LAVI-2D测量值高(P均<0.05)。PAF患者LATEF平均水平低于对照组,且LAE组LATEF水平小于LAN组(P均<0.05)。与对照组比较,PAF患者mSSL、mSRs、mSRe和mSRa水平均降低,LAE组mSSL、mSRs、mSRe和mSRa水平小于LAN组,差异有统计学意义(P均<0.05)。结论三维超声心动图较二维测量左心房容积大,能更准确评估左心房容积。左心房容积无明显增大房颤患者,已出现左心房功能减低。左心房扩大者应变指标进一步下降,左心房功能减低明显。三维超声心动图及斑点追踪成像能早期评价房颤患者左心房功能异常。

Objective To assess left artial(LA)structure and function of paroxysmal atrial fibrillation(PAF)patients with left atrial geometry patterns by real-time 3-dimension echocardiography(RT-3DE)and 2-dimension(2D)speckle tracking imaging(STI).Methods 98 paroxysmal atrial fibrillation(PAF)patients were chosen from the Seventh Medical Center of Chinese PLA General Hospital from Jan.2017 to Dec.2018,and divided into LAN group(n=50)which left atrial volume index(LAVI)<34 ml/m2 and LAE group(n=48)which LAVI≥34 ml/m2,according to LAVI-2D.Thirty-eight patients with matching clinical data were selected as the control group.The left atrial maximum volume(LAVmax),the left atrial minimum volume(LAVmin),the left atrial volume index(LAVI-3D),and the left atrial total emptying fraction(LATEF)were measured by RT-3DE.The mean mean peak longitudinal strain(mSSL)and mean peak strain rates(mSRs,mSRe,and mSRa)were measured on the strain-time curve acquired by 2D-STI.Results The average level of LAVI in PAF patients was higher than that in control group,and the level of LAVI in LAE group was higher than that in LAN group,the measured values of LAVI-3D were higher than those of LAVI-2D(all P<0.05).The average level of LATEF in PAF patients was lower than that in control group,and the level of LATEF in LAE group was lower than that in LAN group(all P<0.05).Compared with the control group,the levels of mSSL,mSRs,mSRe and mSRa in PAF patients decreased.The levels of mSSL,mSRs,mSRe and mSRa in the LAE group were lower than those in the LAN group,and the differences were statistically significant(P<0.05).Conclusions Three-dimensional echocardiography is more accurate than two-dimensional measurement of left atrial volume.In patients with atrial fibrillation without significant increase in left atrial volume,left atrial function has been reduced.The left atrial enlargement strain index further decreased,and the left atrial function decreased significantly.Three-dimensional echocardiography and speckle tracking imaging can early evaluate left atrial dysfunction in patients with AF.