风湿性二尖瓣狭窄及持续性房颤对左心耳形态学及功能学超声指标的影响

Effect of rheumatic mitral stenosis and persistent atrial fibrillation on morphological and functional ultrasound indices of left atrial appendage

目的 探讨风湿性二尖瓣狭窄(RMS)及持续性房颤(PeAF)对左心耳形态学和功能学超声指标的影响。方法 回顾性分析57例RMS合并PeAF(RMS-PeAF)患者(RMS-PeAF组)、22例单纯RMS患者(RMS组)、31例单纯PeAF患者(PeAF组)及40例正常健康者(正常对照组)的临床资料。比较4组的左心耳形态学超声指标[左心耳最大切面面积指数(LAAAImax)、左心耳最小切面面积指数(LAAAImin)、左心耳最大体积指数(LAAVImax)、左心耳最小体积指数(LAAVImin)、左心耳入口最大径线指数(LAAODImax)、左心耳长度指数(LAALI)]和左心耳功能学超声指标[左心耳血流充盈峰值速度(LAA-PFV)、左心耳血流排空峰值速度(LAA-PEV)、左心耳前壁收缩运动速度(LAA-AWSV)、左心耳前壁舒张运动速度(LAA-AWDV)、LAA-PFV/LAA-AWDV值、左心耳面积缩小率(LAAAR)、左心耳射血分数(LAAEF)],以及左心耳自发声学显影(SEC)分级。结果 (1)RMS-PeAF组的LAAAImax、LAAAImin、LAALI、LAAODImax大于PeAF组、正常对照组,LAAVImax、LAAVImin大于其余3组(P<0.05);RMS组及PeAF组的LAAAImin、LAAVImin、LAALI、LAAODImax大于正常对照组,且RMS组的LAAODImax大于PeAF组(P<0.05)。(2)RMS-PeAF组的LAA-PFV、LAAAR、LAAEF小于其余3组,LAA-PEV小于正常对照组,LAA-AWSV、LAA-AWDV小于PeAF组和正常对照组,LAA-PFV/LAA-AWDV值大于PeAF组(P<0.05);RMS组的LAA-PFV、LAA-PEV、LAAAR、LAAEF小于正常对照组,LAA-AWSV、LAA-AWDV小于PeAF组和正常对照组,而LAA-PFV/LAA-AWDV值大于PeAF组和正常对照组(P<0.05);PeAF组的LAA-PFV、LAA-PEV、LAAAR、LAAEF、LAA-PFV/LAA-AWDV值小于正常对照组(P<0.05)。(3)4组的左心耳SEC分级差异有统计学意义,其中RMS-PeAF组的左心耳SEC分级高于其余3组(P<0.05)。结论 单纯RMS和单纯PeAF对左心耳形态学及部分功能学超声指标的影响程度相似,且二者同时存在会产生叠加效应,但RMS对心耳前壁运动的抑制作用更为显著。

Objective To investigate the effect of rheumatic mitral stenosis(RMS)and persistent atrial fibrillation(PeAF)on morphological and functional ultrasound indices of left atrial appendage.Methods The clinical data of 57 patients with RMS and concomitant PeAF(the RMS-PeAF group),22 patients with simple RMS(the RMS group),31 patients with simple PeAF(the PeAF group),and 40 normal healthy individuals(the normal control group)were retrospectively analyzed.The morphological ultrasound indices of left atrial appendage in terms of the maximum section area index of left atrial appendage(LAAAImax),minimum section area index of left atrial appendage(LAAAImin),maximum volume index of left atrial appendage(LAAVImax),minimum volume index of left atrial appendage(LAAVImin),maximum orifice dimension index of left atrial appendage(LAAODImax),and left atrial appendage length index(LAALI),as well as functional ultrasound indices of left atrial appendage(peak filling velocity of left atrial appendage[LAA-PFV],peak emptying velocity of left atrial appendage[LAA-PEV],anterior wall systolic velocity of left atrial appendage[LAA-AWSV],anterior wall diastolic velocity of left atrial appendage[LAA-AWDV],LAA-PFV/LAA-AWDV value,reduction rate of left atrial appendage area[LAAAR],ejection fraction of left atrial appendage[LAAEF]);moreover,spontaneous echo contrast[SEC]grading of left atrial appendage were compared between the four groups.Results(1)The RMS-PeAF group exhibited larger LAAAImax,LAAAImin,LAALI,and LAAODImax as compared with the PeAF and normal control groups,and larger LAAVImax and LAAVImin as compared with the remaining 3 groups(P<0.05).The RMS and PeAF groups interpreted larger LAAAImin,LAAVImin,LAALI,and LAAODImax as compared with the normal control group,and LAAODImax of the RMS group was larger than that of the PeAF group(P<0.05).(2)The RMS-PeAF group implied smaller LAA-PFV,LAAAR,LAAEF as compared with the remaining 3 groups,a smaller LAA-PEV as compared with the normal control group,smaller LAA-AWSV and LAA-AWDV as compared with the PeAF and normal control groups,and a larger LAA-PFV/LAA-AWDV value as compared with the PeAF group(P<0.05).The RMS group yielded smaller LAA-PFV,LAA-PEV,LAAAR,LAAEF as compared with the normal control group,smaller LAA-AWSV and LAA-AWDV as compared with the PeAF and normal control groups,whereas a larger LAA-PFV/LAA-AWDV value as compared with the PeAF and normal control groups(P<0.05).The PeAF group depicted smaller LAA-PFV,LAA-PEV,LAAAR,LAAEF,and LAA-PFV/LAA-AWDV value as compared with the normal control group(P<0.05).(3)There was a statistically significant difference in SEC grading of left atrial appendage between the 4 groups,therein SEC grading of left atrial appendage of the RMS-PeAF group was higher than that of the remaining 3 groups(P<0.05).Conclusion Simple RMS and simple PeAF have similar effect degrees on morphological and partially functional ultrasound indices of left atrial appendage,and the coexistence of the two will produce a superimposed effect;however,RMS exerts a more significant effect on the inhibition of atrial appendage anterior wall movement.