三维超声心动图及二维斑点追踪成像对持续性心房颤动复律后双心房逆向重构的评估

Biatrial structure and function reverse remodelling in patients with persistent atrial fibrillation after cardioversion:evidence from three dimensional echocardiography and two dimensional speckle tracking imaging

目的应用实时三维超声心动图(RT3DE)及二维斑点追踪成像(2DSTI)技术评估持续性心房颤动(PeAF)复律后窦性心律维持者双心房内径、容积、应变的变化,探讨双心房结构和功能的逆向重构。方法这是一项前瞻性研究。纳入2020年8月至2021年12月于重庆医科大学附属第二医院心内科成功复律且随访3个月未复发的PeAF患者21例(病例组),以及在重庆医科大学附属第二医院体检的18例健康志愿者(正常对照组)。应用常规超声、RT3DE、2DSTI对其进行心房结构和功能的评估,21例PeAF患者分别于复律后2 d(M0)、1个月(M1)、3个月(M3)进行超声评估。评估包括二维参数:左心房前后径(LAAPD)、左心房左右径(LALRD)、左心房上下径(LASID)、右心房横径(RACD)、左心室射血分数(LVEF)、二尖瓣口舒张早期峰值流速/二尖瓣环舒张早期峰值运动速度(E/e');双心房三维容积及容积指数:左心房/右心房最大容积(LAVmax/RAVmax)、左心房/右心房P波前容积(LAVpre/RAVpre)、左心房/右心房最小容积(LAVmin/RAVmin)、左心房/右心房最大容积指数(LAVImax/RAVImax)、左心房/右心房P波前容积指数(LAVIpre/RAVIpre)、左心房/右心房最小容积指数(LAVImin/RAVImin);三维射血分数:左心房/右心房总射血分数(LATEF/RATEF)、左心房/右心房被动射血分数(LAPEF/RAPEF)、左心房/右心房主动射血分数(LAAEF/RAAEF);三维扩张指数:左心房/右心房扩张指数(LAEI/RAEI);二维心房应变:左心房/右心房储存期应变(LASr/RASr)、左心房/右心房管道期应变(LAScd/RAScd)、左心房/右心房收缩期应变(LASct/RASct)。对比分析正常对照组与病例组M0、M1、M3各组间参数的差异。结果PeAF复律后,随着窦性心律维持时间延长,二维参数LAAPD、LALRD、LASID、RACD,双心房容积及容积指数LAVmax/RAVmax、LAVpre/RAVpre、LAVmin/RAVmin、LAVImax/RAVImax、LAVIpre/RAVIpre、LAVImin/RAVImin逐渐减小(P均<0.05);双心房应变LASr/RASr、LAScd/RAScd、LASct/RASct,射血分数RATEF、RAPEF、LAAEF/RAAEF、LAEI/RAEI总体增加(P均<0.05);LATEF、LAPEF无明显变化(P均>0.05)。病例组M3的RAVImax(P=0.532)、LAScd(P=0.180)及病例组M1的RAScd(P=0.188)与正常对照组比较差异无统计学意义,其余参数与对照者相比差异仍有统计学意义(P均<0.05)。结论PeAF患者复律后随着窦性心律维持双心房结构和功能均发生一定程度的逆向重构,RT3DE、2DSTI可对其进行评估;右心房可能较左心房更早、更容易发生逆向重构。

Objective To explore the bilateral atrial structure and function reverse remodelling by using real-time three dimensional echocardiography(RT3DE)and two dimensional speckle tracking imaging(2DSTI)to evaluate the biatrial diameter,volume,and function changes in persistent atrial fibrillation(PeAF)patients with sinus rhythm after cardioversion.Methods This is a prospective study in which 21 patients with PeAF who had been successfully cardioverted at the Cardiology Department of the Second Affiliated Hospital of Chongqing Medical University from August 2020 to December 2021 with no recurrence after 3 months of follow-up were included(case group),as well as 18 healthy volunteers(healthy control group)who underwent physical examination at the Second Affiliated Hospital of Chongqing Medical University.The subjects had their atrial diameter,volume,and function evaluated by conventional ultrasound,RT3DE,and 2DSTI.Patients with PeAF were assessed at 2 days(M0),1 month(M1),and 3 months(M3)after cardioversion.The right atrial and left atrial parameters assessed included:left atrial anteroposterior diameter(LAAPD),left atrial left-right diameter(LALRD),left atrial superior-inferior diameter(LASID),right atrial transverse diameter(RATD),left ventricular ejection fraction(LVEF),the ratio of early diastolic mitral inflow velocity to early diastolic myocardial relaxation velocity(E/e'),left atrial/right atrial maximal volume(LAVmax/RAVmax),left atrial/right atrial pre-P wave volume(LAVpre/RAVpre),left atrial/right atrial minimal volume(LAVmin/RAVmin),left atrial/right atrial maximal volume index(LAVImax/RAVImax),left atrial/right atrial pre-P wave volume index(LAVIpre/RAVIpre),left atrial/right atrial minimal volume index(LAVImin/RAVImin),left atrial/right atrial total ejection fraction(LATEF/RATEF),left atrial/right atrial passive ejection fraction(LAPEF/RAPEF),left atrial/right atrial active ejection fraction(LAAEF/RAAEF),left atrial/right atrial expansion index(LAEI/RAEI),left atrial/right atrial strain during reservoir phase(LASr/RASr),left atrial/right atrial strain during conduit phase(LAScd/RAScd),and left atrial/right atrial strain during contraction phase(LASct/RASct).The differences in the above parameters between the healthy control group and the case group at M0,M1,and M3 were compared and analyzed.Results LAAPD,LALRD,LASID,RATD,LAVmax/RAVmax,LAVpre/RAVpre,LAVmin/RAVmin,LAVImax/RAVImax,LAVIpre/RAVIpre,and LAVImin/RAVImin decreased gradually after cardioversion(P<0.05),LASr/RASr,LAScd/RAScd,LASct/RASct,RATEF,RAPEF,LAAEF/RAAEF,and LAEI/RAEI increased after cardioversion(P<0.05),but there were no significant changes in LATEF and LAPEF(P>0.05).The RAVImax(P=0.532)and LAScd(P=0.180)at M3 and RAScd(P=0.188)at M1 in the case group had no significant changes compared with those of the healthy control group,but the other parameters were statistically significant from those of the healthy control group(P<0.05).Conclusion RT3DE and 2D-STI are useful in the evaluation of biatrial reverse remodelling in successfully cardioverted patients with PeAF.The right artium may have greater and faster ability to conduct reverse structure and function remodelling in PeAF patients after cardioversion than the left artium.