经食管超声心动图联合组织速度成像对持续性房颤患者左心耳血栓形成的预测价值

Predictive value of transesophageal echocardiography combined with tissue velocity imaging for left auricle thrombosis in patients with persistent atrial fibrillation

目的分析经食管超声心动图联合组织速度成像对持续性房颤患者左心耳血栓形成的预测价值。方法选取2018年1月至2019年6月于台州市第一人民医院确诊的持续性房颤患者55例纳入研究组,选取同期进行健康体检的志愿者55名纳入对照组。两组受试者均进行经食管超声心动图、组织速度成像检测,比较两组受试者的常规左心房指标、左心耳前后壁中间段、基底段的峰值速度。结果研究组患者的心率、左心房最大容积显著高于对照组,左心房射血分数显著低于对照组(P<0.05)。55例持续性房颤患者中,共检出左心耳内血栓20例,其中血栓位于左心耳入口处6例,左心耳顶部6例,左心耳中部8例。无血栓组和血栓组患者左心耳壁各节段的收缩期峰值速度、舒张期峰值速度均显著低于对照组(P<0.05);血栓组患者左心耳壁各节段的收缩期峰值速度、舒张期峰值速度均显著低于无血栓组(P<0.05)。无血栓组和血栓组患者的左心耳最大容积(left atrial appendage maximum volume,LAAVmax)显著高于对照组(P<0.05),左房主动射血分数(left atrial active ejection fraction,LAAEF)、左心耳排空速度(left atrial appendage emptying velocity,LAA-EV)、左心耳血流平均排空速度(left atrial appendage average emptying flow velocity,LAA-AEV)、左心耳血流峰值充盈速度(left atrial appendage filling peak flow velocity,LAA-FV)均显著低于对照组(P<0.05);血栓组患者的LAAVmax显著高于无血栓组(P<0.05),LAAEF、LAA-EV、LAA-AEV、LAA-FV均显著低于无血栓组(P<0.05)。与经食管超声心动图、组织速度成像单项诊断相比,联合诊断对左心耳血栓形成的敏感度、特异性、准确性均更高(P<0.05)。结论经食管超声心动图联合组织速度成像可全面评估患者的左心房功能、左心耳功能,在预测左心耳血栓的形成中具有较高价值。

Objective To analyze the predictive value of transesophageal echocardiography combined with tissue velocity imaging for left auricle thrombosis in patients with persistent atrial fibrillation.Methods Fifty-five patients with persistent atrial fibrillation diagnosed at Taizhou First People’s Hospital from January 2018 to June 2019 were selected as the study group,while 55 healthy volunteers were selected as the control group.Transesophageal echocardiography and tissue velocity imaging were performed in both groups to compare the conventional left atrial indexes,and the peak velocity of the middle and basal segments of the anterior and posterior walls of left auricle.Results The heart rate and maximum volume of left atrium of study group were significantly higher than those of control group,and the ejection fraction of left atrium was significantly lower than that of control group(P<0.05).In 55 patients with persistent atrial fibrillation,20 cases of left auricle thrombus were detected,including 6 cases at the entrance of left auricle,6 cases at the top of left auricle,and 8 cases at the middle of left auricle.The systolic peak velocity and diastolic peak velocity of each segment of the left auricle wall in non-thrombus group and thrombus group were significantly lower than those of control group(P<0.05).The systolic peak velocity and diastolic peak velocity of each segment of the left auricle wall in thrombus group were significantly lower than those in non-thrombus group(P<0.05).The left atrial appendage maximum volume(LAAVmax)of patients in non-thrombus group and thrombus group was significantly higher than that in control group(P<0.05),and left atrial active ejection fraction(LAAEF),left atrial appendage emptying velocity(LAA-EV),left atrial appendage average emptying flow velocity(LAA-AEV)and left atrial appendage filling peak flow velocity(LAA-FV)were significantly lower than those in control group(P<0.05).The LAAVmax in thrombus group was significantly higher than that in non-thrombus group(P<0.05),and the LAAEF,LAA-EV,LAA-AEV and LAA-FV were significantly lower than those in non-thrombus group(P<0.05).Compared with single diagnosis using transesophageal echocardiography and tissue velocity imaging,the combined diagnosis had higher sensitivity,specificity,and accuracy in detecting left auricle thrombosis(P<0.05).Conclusion Transesophageal echocardiography combined with tissue velocity imaging can comprehensively evaluate the left atrial and left auricle function of patients,and has a high value in predicting the formation of left auricle thrombosis.