超声心动图用于非瓣膜病性心房颤动患者卒中危险分层

Echocardiography in stroke risk stratification of non-valvular atrial fibrillation patients

目的观察超声心动图用于非瓣膜病性心房颤动(NVAF)患者卒中危险分层的价值。方法根据CHA_(2) DS_(2)-VASc评分将90例NVAF患者分为低危组(17例)、中危组(40例)及高危组(33例),对比其血清脑钠肽(BNP)、肌钙蛋白Ⅰ(TnⅠ)及超声参数左心房前后径(LAD)、左心房容积指数(LAVI)、二尖瓣口舒张期流速(E)、二尖瓣环舒张期运动速度(e’)和左心耳(LAA)排空速度(V LAA)、口部直径(D 1)、内侧壁应变(S内)和外侧壁应变(S外)等。结果高危组BNP明显高于中、低危组(P均<0.05),高危组TnⅠ明显高于低危组(P<0.05)。高危组LAVI明显高于中危组(P<0.05),中危组LAVI明显高于低危组(P<0.05);高危组LAD、e’及E/e’均明显大于低危组(P均<0.05)。高危组V LAA明显低于中、低危组(P均<0.05),中危组V LAA明显低于低危组(P<0.05);高危组D 1、S内及S外均明显高于低危组(P均<0.05)。结论超声心动图LAVI、V LAA和LAA应变等参数对于NVAF患者卒中危险分层具有一定临床应用价值。

Objective To observe the value of echocardiography in stroke risk stratification of patients with non-valvular atrial fibrillation(NVAF).Methods A total of 90 NVAF patients were enrolled.Stroke risk stratification was performed according to CHA_(2) DS_(2)-VASc scoring system,and the patients were divided into low-risk group(n=17),medium-risk group(n=40)and high-risk group(n=33).The serum brain natriuretic peptide(BNP),cardiac troponinⅠ(TnⅠ)and ultrasonic parameters,including anteroposterior left atrium diameter(LAD),left atrial volume index(LAVI),mitral diastolic velocity(E),mitral valve ring diastolic velocity(e')and left atrial appendage(LAA)velocity(V LAA),orifice diameter(D 1),inner wall strain(S inner)and external wall strain(S external),etc.were compared among 3 groups.Results BNP in high-risk group was significantly higher than that in medium-and low-risk groups(both P<0.05),and TnⅠin high-risk group was significantly higher than that in low-risk group(P<0.05).LAVI in high-risk group was significantly higher than that in medium-risk group(P<0.05),and in medium-risk group was significantly higher than that in low-risk group(P<0.05).LAD,e'and E/e'in high-risk group were significantly higher than those in low risk group(all P<0.05).V LAA in high-risk group was significantly lower than that in medium-risk group(P<0.05),and in medium-risk group was significantly lower than in low-risk group(P<0.05).D 1,S inner and S external in high-risk group were all significantly higher than those in low risk group(all P<0.05).Conclusion Echocardiographic parameters,such as LAVI,V LAA and strain of LAA had certain clinical application valuable for stroke risk stratification.