不同类型心房颤动患者心房容积及应变参数对病程进展的预测价值

Predictive value of atrial volume and strain parameters for disease progression in patients with different types of atrial fibrillation

目的应用二维斑点超声心动图(2D-STE)及实时三维超声心动图(RT-3DE)评估持续性心房颤动(per-AF)及阵发性心房颤动(PAF)患者心脏形态及功能参数,探究其对心房颤动发生及进展的预测价值。方法回顾性纳入2022年5月至2023年5月于武汉大学人民医院行超声心动图检查的30例per-AF患者(per-AF组)、30例PAF患者(PAF组)和25例健康体检者(对照组)。2D-STE评估代表储存、管道和收缩功能的左/右心房纵向应变(LASr/RASr、LAScd/RAScd、LASct/RASct),并计算左心房僵硬度(LASI)。RT-3DE获取三维左/右心房最大容积指数(LAVImax/RAVImax)、左/右心房最小容积指数(LAVImin/RAVImin)和左/右心房总排空分数(LAEF/RAEF)。将心房颤动患者分为LAVI正常组及LAVI增大组,比较各组间心房应变的差异。利用ROC曲线评价超声参数对左心房容积正常的心房颤动患者的总体诊断效果及截断值。将以上超声参数建立多因素Logistic回归模型,筛选出与不同类型心房颤动发生的相关超声参数。结果①结构上,对照组、PAF组、per-AF组左心房前后径(LAD)、右心房左右径(RAD)、RAVImin逐次增大,LAEF、RAEF逐次减小(均P<0.05)。②应变上,对照组、PAF组、per-AF组LASr逐次减小(均P<0.05);与对照组相比,PAF组及per-AF组LAScd、RASr、RAScd绝对值明显减小,PAF组LASct、RASct绝对值明显减小(均P<0.05)。③与LAVI正常组比较,LAVI增大组LASr、LAScd、LASct绝对值降低,LASI升高(均P<0.05);与对照组比较,LAVI正常组左、右心房各应变参数降低,LASI升高(均P<0.05)。构建左心房容积正常受试者心房应变参数ROC曲线,显示RASr识别心房颤动患者的ROC曲线下面积(AUC)最大。④多因素Logistic回归分析显示,LAVImin、RASr是PAF的影响因素(OR=1.521、0.907,95%CI=1.173~1.972、0.825~0.998,P=0.002、0.044);LASr是per-AF的影响因素(OR=0.858,95%CI=0.802~0.917,P<0.001)。结论运用2D-STE和RT-3DE可评估双心房结构和功能变化,其中LAVImin、LASr、RASr对心房颤动的发生及进展有一定预测价值。

Objective To evaluate the cardiac morphological and functional parameters of patients with persistent atrial fibrillation(per-AF)and paroxysmal atrial fibrillation(PAF)using two-dimensional speckle tracking echocardiography(2D-STE)and real-time three-dimensional echocardiography(RT-3DE),and to explore their predictive value for the occurrence and progression of atrial fibrillation.Methods A retrospective study was conducted on 30 per-AF patients(per-AF group),30 PAF patients(PAF group)and 25 non-AF subjects(control group)who underwent echocardiography at Wuhan University People′s Hospital from May 2022 to May 2023.The left/right atrial longitudinal strain of reservoir,conduct and contraction(LASr/RASr,LAScd/RAScd,LASct/RASct),and calculated left atrial stiffness(LASI)were assessed by 2D-STE.Three-dimensional left and right atrial maximum volume index(LAVImax/RAVImax),minimum volume index(LAVImin/RAVImin)and emptying fraction(LAEF/RAEF)were obtained by RT-3DE.Then,patients with atrial fibrillation were divided into the normal LAVI group and enlarged LAVI group,and the differences of atrial strain among each group were compared.ROC curve was used to evaluate the overall diagnostic efficiency and cutoff values of ultrasonic parameters in patients with normal volume of atrial fibrillation.Finally,a multivariate Logistic regression model was established to identify the ultrasonic parameters associated with the occurrence and progression of different types of atrial fibrillation.Results①Structurally,LAD,RAD and RAVImin in control,PAF and per-AF groups increased gradually,while LAEF and RAEF decreased gradually(all P<0.05).②In terms of strain,LASr in control,PAF and per-AF groups decreased gradually(all P<0.05);Compared with the control group,LAScd,RASr and RAScd in PAF and per-AF groups were significantly decreased,and LASct and RASct in PAF group were significantly decreased(all P<0.05).③Compared with the normal LAVI group,the LASr,LAScd and LASct in the enlarged LAVI group were significantly decreased,while LASI was significantly increased(all P<0.05);Compared with control group,the left and right atrial strain parameters in LAVI normal group were decreased,and LASI was increased(all P<0.05).The atrial strain parameter ROC was constructed in all subjects with normal left atrial volume,and RASr was the most sensitive indicator.④Multi-factor Logistic regression analysis showed that LAVImin and RASr were the influence factors of PAF(OR=1.521,0.907;95%CI=1.173-1.972,0.825-0.998;P=0.002,0.044),LASr was the influence factor of pre-AF(OR=0.858,95%CI=0.802-0.917,P<0.001).Conclusions 2D-STE and RT-3DE can be used to evaluate the structural and functional changes of both atria,especially LAVImin,LASr and RASr,which have certain predictive value for the occurrence and progression of atrial fibrillation.