斑点追踪技术评估病态窦房结综合征伴阵发性心房颤动患者左室功能

Assessment of left ventricular function in patients with sick sinus syndrome and paroxysmal atrial fibrillation by speckle tracking imaging

目的探讨斑点追踪技术评估病态窦房结综合征(SSS)伴阵发性心房颤动(PAF)患者左室收缩和舒张功能的临床价值。方法选取SSS不伴PAF组37例,SSS伴PAF组25例,体检健康者30例为对照组,常规超声心动图测量各组左房及右房内径(LAD、RAD)、左室舒张末及收缩末内径(LVEDd、LVEDs)、二尖瓣口舒张早期和晚期峰值流速(E、A)、等容舒张时间(IVRT)、二尖瓣E峰减速时间(EDT)、二尖瓣环舒张早期峰值速度(e’),计算E/A和E/e’;斑点追踪技术测量左室心肌应变及做功参数,包括整体纵向应变(GLS)、达峰时间离散度(PSD)、心肌整体做功指数(GWI)、整体做功效率(GWE)、整体有用功(GCW)、整体无用功(GWW),以及扭转角度峰值(Ptw)、扭转速度峰值(PTV)、解旋速度峰值(PUV)、解旋率(UntwR);比较各组上述参数的差异。结果与对照组比较,SSS不伴PAF组RAD、E/e’、IVRT、整体及心尖段Ptw、PTV,以及PSD、GWW均增大,基底段UntwR、PUV及GWI均减小,差异均有统计学意义(均P<0.05);SSS伴PAF组RAD、LAD、LVEDs、LVESd、E/e’、IVRT均增大,LVEF、E/A、EDT、整体及基底段Ptw、PTV、UntwR、PUV、整体UntwR及GWI、GCW均减小,差异均有统计学意义(均P<0.05)。与SSS不伴PAF组比较,SSS伴PAF组LAD、LVEDd、LVESd、IVRT、PSD、GWW均增大,LVEF、EDT、左室整体和各节段Ptw、PTV、PUV、整体UntwR及GLS、GWI、GCW、GWE均减小,差异均有统计学意义(均P<0.05)。结论斑点追踪技术可以早期、定量评估SSS伴PAF患者左室收缩和舒张功能受损情况,具有较好的临床应用价值。

Objective To explore the clinical value of speckle tracking imaging in the evaluation of left ventricular diastolic and systolic function in sick sinus syndrome(SSS)patients with paroxysmal atrial fibrillation(PAF).Methods A Total of 37 SSS patients without PAF as SSS group,25 SSS patients with PAF as SSS with PAF group,30 healthy subjects as control group were selected.The left and right atrial diameters(LAD and RAD),left ventricular end-diastolic and-systolic diameters(LVEDd and LVEDs),peak velocity of early and late diastolic mitral valve(E and A),isovolumic diastolic time(IVRT),mitral E-peak deceleration time(EDT),and early diastolic peak velocity(e’)of mitral annulus,E/A and E/e were measured by conventional echocardiography.The left ventricular myocardial strain and work parameters were measured,including global longitudinal strain(GLS),peak-time dispersion(PSD),global work index(GWI),global work efficiency(GWE),global constructive work(GCW),global wasted work(GWW).And the peak twist(Ptw),peak twist velocity(PTV),peak untwisting velocity(PUV),untwisting rate(UntwR)were also measured.Results Compared with the control group,the RAD,E/e’,IVRT and Ptw,PTV of globe and apical segment,PSD,GWW in SSS group were all increased,while the UntwR,PUV of basal segment and GWI were decreased(all P<0.05).Compared with the control group,the RAD,LAD,LVEDs,LVESd,E/e’and IVRT in SSS with PAF group were increased,while LVEF,E/A,EDT,the Ptw,PTV,UntwR,PUV of globe and basal segment,and GWI,GCW were decreased(all P<0.05).Compared with SSS group,the LAD,LVEDd,LVESd,IVRT,PSD,GWW in SSS with PAF group were increased,while the LVEF,EDT and Ptw,PTV,PUV of globe and each segment were decreased,the global UntwR,GLS,GWI,GCW,GWE were also decreased(all P<0.05).Conclusion Speckle tracking imaging can early and quantitatively evaluate the damage of left ventricular diastolic and systolic function in SSS combined with PAF patients.