实时三维超声心动图联合二维斑点追踪成像评价心房颤动患者左心结构及功能

Evaluation of left heart structure and function in patients with atrial fibrillation by real-time three-dimensional echocardiography combined with two-dimensional speckle tracking echocardiography

目的应用实时三维超声心动图(RT-3DE)联合二维斑点追踪成像(2D-STE)评价心房颤动患者的左心结构及功能。方法选择2018年1月至2020年12月北京积水潭医院心内科住院的心房颤动患者65例为观察对象,依据心房颤动类型分为持续性房颤(PerAF)组(30例)、阵发性房颤(PAF)组(35例)。使用RT-3DE以及2D-STE采集图像,应用QLAB 13.0分析软件,计算左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房排空分数(LAEF)、左房容积指数(LAVI)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左房储库纵向应变(LASr)、左房导管纵向应变(LAScd)、左房收缩纵向应变(LASc)以及左室整体的长轴应变(GLS)。比较两组相关指标,分析LAVI与左房及左室应变相关性。结果两组LAVmax比较,差异无统计学意义(P>0.05);PerAF组LAVmin、LAVI、LVEDV、LVESV高于PAF组,LAEF低于PAF组,差异均有统计学意义(P<0.05)。PerAF组LASr、LAScd、LASc、GLS低于PAF组,差异均有统计学意义(P<0.05)。LAVI与LASr、LAScd、LASc及GLS呈负相关(r=-0.47、-0.49、-0.63、-0.49,P<0.01)。结论PerAF患者的左心重构及功能受损较PAF患者更严重,RT-3DE联合2D-STE可有效评估心房颤动患者的左心结构及功能。

Objective To evaluate of left heart structure and function in patients with atrial fibrillation by real-time three-dimensional echocardiography(RT-3DE)and two-dimensional speckle tracking echocardiography(2D-STE).Methods A total of 65 patients with atrial fibrillation hospitalized in Department of Cardiology,Beijing Jishuitan Hospital from January 2018 to December 2020 were selected as observation subjects.According to the type of atrial fibrillation,they were divided into persistent atrial fibrillation(PerAF)group(30 cases)and paroxysmal atrial fibrillation(PAF)group(35 cases).RT-3DE and 2D-STE were used to collect images,and QLAB 13.0 analysis software was used,maximum left atrial volume(LAVmax),left atrial emptying fraction(LAEF),left atrial volume index(LAVI),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left atrial reservoir strain(LASr),left atrial conduit strain(LAScd),left atrial contraction strain(LASc),and left ventricular global longitudinal strain(GLS)were calculated.The related indicators of two groups were compared,and the correlation between LAVI and left atrium and left ventricle strain were analyzed.Results There were no significant differences in LAVmax between two groups(P>0.05);LAVmin,LAVI,LVEDV,and LVESV in PerAF group were higher than those in PAF group,while LAEF was lower than that in PAF group,and the differences were statistically significant(P<0.05).LASr,LAScd,LASc,and GLS in PerAF group were lower than those in PAF group,and the differences were statistically significant(P<0.05).LAVI was negatively correlated with LASr,LAScd,LASc,and GLS(r=-0.47,-0.49,-0.63,-0.49,P<0.01).Conclusion The left heart remodeling and functional impairment in patients with PerAF are more serious than those in patients with PAF.RT-3DE combined with 2D-STE can effectively evaluate the left heart structure and function in patients with atrial fibrillation.