经食管超声心动图联合组织多普勒应变率成像对非瓣膜性心房颤动患者左心耳整体功能评估的研究

Evaluation of the global function of left atrial appendage in patients with nonvalvular atrial fibrillation by transesophageal echocardiography combined with tissue Doppler strain rate imaging

目的:探讨采用经食管超声心动图联合组织多普勒应变率成像方法评估非瓣膜性心房颤动(NVAF)患者左心耳的整体功能。方法:选取2020年1月至2021年9月因NVAF就诊于解放军总医院第六医学中心的78例患者作为病例组和30例同期健康者作为对照组,2组均接受经食管超声心动图检查和使用组织多普勒应变率成像,对比2组间左心耳常规参数和左心耳整体运动速度、位移、应变及应变率。依据是否合并左心耳血栓将NVAF患者进一步分为血栓组和无血栓组,采用多因素Logistic回归分析血栓形成的危险因素。结果:NVAF组左心耳宽度大于对照组(P<0.05),左心耳射血分数、排空流速、平均位移、收缩期运动速度、舒张期运动速度、收缩期应变、舒张期应变、收缩期应变率、舒张期应变率均低于对照组(均P<0.05);血栓组左心耳射血分数、排空流速、平均位移、收缩期运动速度、舒张期应变、舒张期应变率均低于无血栓组(均P<0.05);多因素Logistic回归结果提示排空流速、收缩期运动速度、舒张期应变率是左心耳血栓形成的危险因素(均P<0.05)。结论:经食管超声心动图联合组织多普勒应变率成像可对NVAF患者左心耳结构和整体功能进行评估,左心耳血栓形成与左心耳排空流速、收缩期运动速度、舒张期应变率降低有关。

Objective To appraise the evaluation of the global function of left atrial appendage(LAA)in patients with nonvalvular atrial fibrillation(NVAF)by transesophageal echocardiography combined with tissue Doppler strain rate imaging.Methods A total of 78 patients with NVAF(NVAF group)admitted to the Sixth Medical Center of PLA General Hospital from January 2020 to September 2021 and 30 outpatients with patent foramen ovale(PFO)or suspected PFO(whose ECG and transthoracic echocardiography showed no abnormalities)in the same time period were selected,as the NVAF group and the control group,and undergone transesophageal echocardiography examination combined with tissue Doppler strain rate imaging.The general parameters,as well as overall movement speed,displacement,strain,and strain rate of LAA were compared between the two groups.The patients with NVAF were further divided into thrombosis subgroup and non-thrombosis subgroup according to whether they had LAA thrombosis or not.Multivariate logistic regression was used to analyze the risk factors of LAA thrombosis.Results The widths of LAA in the NVAF subgroups were larger than those in the control group(P<0.05),and the ejection fraction,emptying velocity,average displacement,systolic velocity,diastolic velocity,systolic strain,diastolic strain,systolic strain rate,and diastolic strain rate of LAA were all lower than those in the control group(all P<0.05);and the ejection fraction,emptying velocity,average displacement,systolic velocity,diastolic strain,and diastolic strain rate of LAA in the thrombosis subgroup were lower than those in the non-thrombosis subgroup(all P<0.05).Multivariate logistic regression showed that emptying velocity,systolic velocity,and diastolic strain rate were the risk factors of LAA thrombosis(all P<0.05).Conclusion Transesophageal echocardiography combined with tissue Doppler strain rate imaging can evaluate the structure and global function of LAA in NVAF patients.The LAA thrombosis is related to the decreases of emptying velocity,systolic velocity,and diastolic strain rate of LAA.