非风湿性房颤患者肺静脉血流超声特征及其与左心耳改变的关系

Echocardiographic Characteristics of Pulmonary Venous Flow and Its Relationship to Left Atrial Appendage in Patients with Nonrheumatic Atrial Fibrillation

目的 了解非风湿性房颤 (NRH- AF)患者的肺静脉血流 (PVF)超声特征及其与左心耳(L AA)改变间的关系。方法 研究了 2 0例正常人 PVF超声特征和 36例 NRH- AF患者的 PVF及 L AA超声特点。结果 L AA血流频谱清晰型 (峰速≥ 2 5 cm/s,占 6 1 .5 % )和 L AA血流频谱模糊型 (峰速 <2 5 cm/s,占 38.5 % )两组患者的 PVF频谱均表现为收缩期血流 (峰速血流及速度积分 ,Sp及 Si)显著减小而舒张期 PVF峰速血流(Dp)反而增大的正向两相型 (P<0 .0 1 ) ,所有患者房缩期返转波消失或弱不可辨。与前组患者相比 ,后组患者的 Sp及 Si、左心耳面积变化率、左心耳排血峰速、充盈血流峰速均显著减小 ,左心耳最大直径增大 ,自发性回声造影 (SEC)现象检出率显著增高 (6 4 .2 % VS 1 3.5 % ,P<0 .0 1 ) ,且 2 8.5 %患者发现血栓 ,而两组间 Dp、左房室内径、心功能及二尖瓣环下降幅度无显著性差异 (P>0 .0 5 )。相关分析表明 :患者 PVF的 Sp与左心耳面积变化率、左心耳排血峰速、充盈血流峰速及左心耳最大直径有良好的相关性 (r为 0 .6 8;0 .6 0 ;0 .4 2 ;- 0 .5 2 ,P<0 .0 1 )。结论 非风湿性房颤患者的 PVF变化有其特点且与 L AA功能改变间关系密切 ,理解 PVF表现应考虑L AA的作用 ,超声观察 PVF亦可能有助了解患者 L

Objective To observe the echocardiographic characteristics of pulmonary venous flow(PVF) and its relationship to left atrial appendage(LAA)in patients with nonrheumatic atrial fibrillation. Methods The PVF in 20 normal subjects and the LAA and the PVF in 36 patients were studied on echocardiography. Results The PVF velocity pattern with a decresed systolic flow,an incresed diastolic flow but without atrial systolic flow were found in all patients while the LAA flow pattern revealed with well defined peak filling and emptying waves(≥25 cm/s) in 22 subjects (61 5%) and that with irregular and lower flow waves(<25 cm/s) in the 14 subjects (38 5%) were also detected. Compared with patients with the first LAA flow pattern,the peak velocity and velocity time integrals of PVF during systole,the rate of the changed LAA area,the peak emptying and filling velocities of LAA were significiently lower; the LAA diameter were bigger,and the spontaneous echo contrast phenomenon was observed more frequently in the patients with the second LAA flow pattern( P <0 01). But there was no significient difference in the peak velocity of PVF during diastole,lefe atrial diameter and its function,left ventricular diameter and its function and the descent of mitrial anulus between two groups of patients.The peak velocity of PVF during systole (Sp) was correlated better with the rate of the changed LAA area,the peak emptying velocities of LAA flow,the filling velocities of LAA flow and the LAA diameter( r =0 68;0 60;0 42;-0 52, P <0 01)respectively.Conclusions There was relationship between the characteristic changes of PVF during systole and function of LAA in patients with nonrheumatic atrial fibrillation.It might be good for us to understand the changes of PVF through taking account of this relationship.And it also might be helpful for us to learn function of LAA from examining PVF on echocardiography.