经食管超声心动图定量参数与心房颤动患者射频消融术后复发的关系探究

Relationship between quantitative transesophageal echocardiographic parameters and recurrence after radiofrequency ablation in patients with atrial fibrillation

目的 探讨经食管超声心动图定量参数对心房颤动(房颤)患者心耳血栓的诊断价值,并分析与其射频消融术(RFCA)后复发的关系。方法 选取2019年4月~2022年10月皖南医学院第二附属医院80例房颤患者,根据患者是否存在左心耳(LAA)血栓将其分为血栓组(n=14)与非血栓组(n=66)。比较两组经食管超声心动图定量参数[左心室射血分数(LVEF)、左心房内径(LAD)、最大面积(LAAmax)、最小面积(LAAmin)、左心耳血流充盈速度(LFFV)、左心耳血流排空速度(LFEV)、左心耳射血分数(LAAEF)],分析其对房颤患者心耳血栓的诊断价值;比较房颤RFCA术后复发与未复发患者临床资料及经食管超声心动图定量参数,分析房颤RFCA术后复发的影响因素。结果 血栓组LFEV、LFFV及LAAEF均低于非血栓组,LAD、LAAmax、LAAmin高于非血栓组(P<0.05);房颤RFCA术后复发患者年龄、卒中/TIA及心耳血栓比例高于未复发患者(P<0.05);房颤RFCA术后复发患者LVEF、LFEV、LFFV及LAAEF均低于未复发患者,LAD、LAAmax、LAAmin高于未复发患者(P<0.05);Logistic回归分析显示,LVEF(OR=0.394)、LFEV(OR=0.531)、LFFV(OR=0.542)及LAAEF(OR=0.438)是房颤RFCA术后复发的独立相关保护因素,年龄(OR=11.734)、卒中/TIA(OR=8.065)、心耳血栓(OR=15.667)、LAD(OR=14.589)、LAAmax(OR=22.385)、LAAmin(OR=22.238)是房颤RFCA术后复发的独立相关危险因素(P<0.05);LVEF、LFEV、LFFV、LFEV、LFFV及LAAEF联合预测RFCA术后复发的AUC值大于单独指标(P<0.05)。结论 经食管超声心动图定量参数联合检测对房颤患者心耳血栓的诊断价值较高,且年龄、卒中/TIA、心耳血栓及经食管超声心动图定量参数与房颤RFCA术后复发有关,可为临床复发的防治提供参考。

Objective To investigate the diagnostic value of quantitative parameters of transesophageal echocardiography in patients with atrial fibrillation(AF)and its relationship with recurrence after radiofrequency ablation(RFCA).Methods Eighty patients with atrial fibrillation in The Second Affiliated Hospital of Wannan Medical College from April 2019 to October 2022 were selected and divided into the thrombotic group(n=14)and non-thrombotic group(n=66)according to the presence of left auricular(LAA)thrombus.Quantitative transesophageal echocardiographic parameters[left ventricular ejection fraction(LVEF),left atrial internal diameter(LAD),maximum area(LAAmax),minimum area(LAAmin),left auricular flow filling velocity(LFFV),left auricular flow emptying velocity(LFEV),left auricular ejection fraction(LAAEF)]were compared between the two groups to explore their diagnostic value for auricular thrombus in patients with atrial fibrillation.Comparing the clinical data and quantitative parameters of transesophageal echocardiography in patients with and without recurrence of atrial fibrillation after RFCA,the factors affecting recurrence of atrial fibrillation were analyzed.Results LFEV,LFFV and LAAEF in thrombus group were lower than those in non-thrombus group,and LAD,LAAmax and LAAmin were higher than those in non-thrombus group(P<0.05).The age,stroke/TIA and proportion of auricular thrombosis in patients with recurrent atrial fibrillation were higher than those without recurrent atrial fibrillation(P<0.05).LVEF,LFEV,LFFV and LAAEF in patients with recurrent RFCA were lower than those without recurrence,while LAD,LAAmax and LAAmin were higher than those without recurrence(P<0.05).Logistic regression analysis showed that LVEF(OR=0.394),LFEV(OR=0.531),LFFV(OR=0.542)and LAAEF(OR=0.438)were the independent protective factors for postoperative recurrence of atrial fibrillation RFCA but age(OR=11.734),stroke/TIA(OR=8.065),auricular thrombosis(OR=15.667),LAD(OR=14.589),LAAmax(OR=22.385),LAAmin(OR=22.238)were the independent risk factors for postoperative recurrence of atrial fibrillation(P<0.05).The AUC values of LVEF,LFEV,LFFV,LFEV,LFFV and LAAEF combined to predict recurrence after RFCA were greater than any one of the indicators(P<0.05).Conclusion The combined transesophageal echocardiographic quantitative parameters are of high diagnostic value in patients with atrial fibrillation with auricular thrombosis;and the age,stroke/TIA,auricular thrombosis and transesophageal echocardiographic quantitative parameters are associated with the recurrence after RFCA in atrial fibrillation,which may provide a reference for the prevention and treatment of clinical recurrence.