| 摘要: |
| 目的 应用经食管超声心动图技术(TEE)评价非瓣膜性心房颤动(房颤)左心耳(LAA)血流动力学变化状况,并探讨其预测LAA血栓形成的价值。方法 房颤组138例和对照组30例接受TEE检查。依据LAA内是否存在血栓将房颤组分为非血栓组(N=123)和血栓组(N=15)。采集0°、45°、90°、135° LAA二维图像,获取 LAA 血流频谱及组织速度成像图像。测量LAA射血分数(LAAEF)、LAA最大容积(LAAVmax)、LAA血流峰值排空速度(LAA-EV)和充盈速度(LAA-FV)、LAA血流平均排空速度(LAA-AEV)和平均充盈速度(LAA-AFV)以及LAA各壁收缩期和舒张期峰值速度。结果 与对照组比较,房颤组LAA-EV、LAA-FV均减低、LAAVmax增高(P<0.01),但无血栓组与血栓组两组相比较,差异无统计学意义。对照组、无血栓组和血栓组三组间LAA-AEV、LAA-AFV、LAAEF以及LAA各壁收缩期和舒张期峰值速度依次减低,差异均有统计学意义(P均<0.01)。LAA-AFV判断发生LAA血栓的截点值为27.5 cm/s,特异性与敏感性分别为80%、87%；LAA-AEV判断发生LAA血栓的截点值为33.0 cm/s,特异性与为敏感性分别为73%、97%。结论 TEE能有效评价LAA血流动力学状态及LAA功能。非瓣膜病性房颤患者LAA收缩、舒张功能减低,LAA血栓形成时减低更甚。LAA血流平均充盈速度与排空速度可以预测非瓣膜病性房颤患者LAA血栓形成的风险。 |
| 关键词: 心房颤动 经食管超声 左心耳 |
| DOI： |
| 投稿时间：2017-03-12修订日期：2017-03-12 |
| 基金项目: |
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| The predictive value of left atrial appendage hemodynamics for left atrial appendage thrombus in patients with nonvalvular atrial fibrillation by transesophageal echocardiography |
| mayuanyuan,guo ruiqiang |
| (Renmin Hospital of Wuhan University) |
| Abstract: |
| Objective To clarify the value of transesophageal echocardiography (TEE) for evaluating left atrial appendage (LAA) hemodynamics and predicting LAA thrombus in patients with nonvalvular atrial fibrillation. Methods 138 atrial fibrillation patients and 30 controls were enrolled in our study. The atrial fibrillation patients were classified into two groups: LAA thrombus group (N=15) and LAA non-thrombus group (N=123). At the 2D-TEE mid-esophageal views, LAA flow spectra and tissue velocity imaging (TVI) of 0, 45, 90 and 135 degree were obtained respectively. LAA ejection fraction (LAAEF), LAA maximal volume (LAAVmax), LAA minimal volume (LAAVmin), LAA filling peak flow velocity (LAA-FV), LAA emptying peak flow velocity (LAA-EV), LAA average filling flow velocity (LAA-AFV), LAA average emptying flow velocity (LAA-AEV), LAA walls systolic and diastolic peak velocity were measured. Results Compared to the control group, LAA-EV, LAA-FV of atrial fibrillation group were lower and LAAVmax were higher (P<0.01). But there were no significant differences between thrombus group and non-thrombus group. LAA-AEV, LAA-AFV, LAAEF gradually reduced in control group, non-thrombus group and thrombus group. The cut-off value of LAA-AEV and LAA-AFV were 33.0cm/s and 27.5cm/s respectively (specificity were 0.80 and 0.73, respectively, sensitivity were 0.87 and 0.97, respectively) for predicting LAA thrombus. Conclusions TEE can effectively reflect LAA hemodynamics and function. The LAA systolic and diastolic function of nonvalvular atrial fibrillation patients are lower, and even worse in those with thrombus. LAA-AEV and LAA-AFV are good parameters which can provide more references for predicting LAA thrombus in nonvalvular atrial fibrillation patients． |
| Key words: Atrial fibrillation Transesophageal echocardiography Left atrial appendage |
