| 摘要: |
| 目的 应用二维斑点追踪技术（2D-STI）联合实时三维超声心动图（RT-3DE）评估心房功能性二尖瓣反流（AFMR）患者导管消融疗效，并探讨术后二尖瓣反流改善的影响因素。方法 选取于我院首次接受导管消融治疗的AFMR患者47例，术后6个月均复查超声心动图，根据术后AFMR是否改善分为改善组（22例）和未改善组（25例）。应用常规超声心动图测量左房前后径（LAD）、二尖瓣环前后径（MAD）、左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）、左室射血分数（LVEF）；应用2D-STI测量左房存储期应变（LASr）、管道期应变（LAScd）、辅泵期应变（LASct）；应用RT-3DE测量左房最大容积（LAVmax）、左房最小容积（LAVmin），计算左房射血分数（LAEF）及左房扩张指数（LAEI），比较两组术前、术后上述参数的差异，分析导管消融术对左房结构与功能重构的影响。采用多因素Logistics回归分析导管消融术后二尖瓣反流改善的影响因素；绘制受试者工作特征（ROC）曲线分析各因素预测导管消融术后疗效的诊断价值。结果 与导管消融术前比较，术后两组心脏结构参数（LAD、MAD及LAVI）均减小，功能参数（LASr、LAScd、LASct、LAEF及LAEI）均增大，差异均有统计学意义（均P＜0.05）。多因素Logistics回归显示，MAD（OR=5.552，95%可信区间：1.796～9.791，P=0.031）、LASr（OR=0.733，95%可信区间：0.552～0.973，P=0.031）均为导管消融术后二尖瓣反流改善的独立预测因子。ROC曲线分析显示，MAD预测二尖瓣反流改善的曲线下面积为0.775，(95%可信区间：0.643～0.908， P=0.001)，最佳截断值为 3.35cm，LASr预测二尖瓣反流改善的曲线下面积为0.735，(95%可信区间：0.590～0.881, P=0.006)，最佳截断值为18.05%。结论 2D-STI联合RT-3DE可以准确评估AFMR患者导管消融术后疗效；MAD、LASr均为导管消融术后二尖瓣反流改善的独立预测因子。 |
| 关键词: 超声心动描记术，三维，实时 斑点追踪，二维 心房颤动 心房功能性二尖瓣反流 导管消融术 |
| DOI： |
| 投稿时间：2023-07-11修订日期：2024-03-11 |
| 基金项目: |
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| Evaluation of the efficacy and influence factor of catheter ablation in patients with atrial functional mitral regurgitation by two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography |
| Li An Ni,Zhou Chang,Gao Xiao Zhan |
| () |
| Abstract: |
| Objective To evaluate the efficacy of catheter ablation of atrial functional mitral regurgitation (AFMR) by two-dimensional speckle tracking imaging (2D-STI) combined with real-time three-dimensional echocardiography (RT-3DE), and to explore the influencing factors for the improvement of mitral regurgitation after catheter ablation.Methods Forty-seven patients with AFMR who underwent catheter ablation for the first time in our hospital were selected. All patients were reexamined by echocardiography at 6 months after ablation. According to whether AFMR improved after ablation, they were divided into improved group (22 cases) and non-improved group (25 cases). The left atrial diameter (LAD), mitral annular diameter (MAD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were measured by conventional echocardiography. 2D-STI was used to measure the left atrial storage period strain (LASr), pipeline period strain (LAScd) and pump period strain (LASct). The maximum left atrial volume (LAVmax) and minimum left atrial volume (LAVmin) were measured by RT-3DE, and the left atrial ejection fraction (LAEF) and left atrial dilatation index (LAEI) were calculated. The differences of the above parameters between the two groups before and after catheter ablation were compared to analyze the effect of catheter ablation on left atrial structure and function remodeling. Multivariate Logistics regression analysis was used to analyze the influencing factors of improvement of mitral regurgitation after catheter ablation. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of each factor in predicting the efficacy of catheter ablation.Results Compared with those before catheter ablation, the cardiac structural parameters (LAD, MAD and LAVI) were decreased, and the functional parameters (LASr, LAScd, LASct, LAEF and LAEI) were increased after catheter ablation in the two groups, and the differences were statistically significant (all P < 0.05). Multivariate logistic regression showed that MAD (OR=5.552, 95% CI: 1.796-9.791, P=0.031), LASr (OR=0.733, 95% CI: 0.552-0.973, P=0.031) were independent predictors of improvement of mitral regurgitation after catheter ablation. ROC curve Compared with those before catheter ablation, the cardiac structural parameters (LAD, MAD and LAVI) were decreased, and the functional parameters (LASr, LAScd, LASct, LAEF and LAEI) were increased after catheter ablation in the two groups, and the differences were statistically significant (all P < 0.05). Multivariate logistic regression showed that MAD (OR=5.552, 95% CI: 1.796-9.791, P=0.031), LASr (OR=0.733, 95% CI: 0.552-0.973, P=0.031) were independent predictors of improvement of mitral regurgitation after catheter ablation. ROC curve analysis showed that the area under the curve of MAD for predicting improvement of mitral regurgitation was 0.775 (95% confidence interval: 0.643-0.908, P=0.001), and the best cut-off value was 3.35cm. The area under the curve of LASr for predicting improvement of mitral regurgitation was 0.735 (95% confidence interval: 0.643-0.908, P=0.001). 0.590-0.881, P=0.006), and the best cut-off value was 18.05%. analysis showed that the area under the curve of MAD for predicting improvement of mitral regurgitation was 0.775 (95% confidence interval: 0.643-0.908, P=0.001), and the best cut-off value was 3.35cm. The area under the curve of LASr for predicting improvement of mitral regurgitation was 0.735 (95% confidence interval: 0.643-0.908, P=0.001). 0.590-0.881, P=0.006), and the best cut-off value was 18.05%.Conclusion 2D-STI combined with RT-3DE can accurately evaluate the efficacy of catheter ablation in patients with AFMR. Both MAD and LASr are independent predictors of improvement of mitral regurgitation after catheter ablation. |
| Key words: Echocardiography,three-dimensional,real-time Speckle trackin,two-dimensional Atrial fibrillation Atrial functional mitral regurgitation Catheter ablation |
