| 摘要: |
| 目的 应用三维斑点追踪技术评估非瓣膜性心房颤动（房颤）患者不同程度左房低电压对左房结构及功能的影响。方法 随机选取我院拟行射频消融术的房颤患者66例，术前记录患者临床资料，均行常规经胸超声心动图检查获得左房收缩末期前后径、左右径、上下径和左室舒张末期内径、左室射血分数（LVEF）、舒张早期二尖瓣血流峰值与二尖瓣环峰值运动速度比值（E/ e’）；三维斑点追踪技术获取左房储器期应变（LASr）、管道期应变（LAScd）、泵功能期应变（LASct）、左房射血分数（LAEF）。进行射频消融术时应用三维电解剖标测技术获得左房低电压区，根据低电压区面积与左房表面积的百分比定义左房低电压区程度，将患者分为无低电压患者组（Ⅰ组）、左房低电压区程度＜10%组（Ⅱ组）、左房低电压区程度≥10%组（Ⅲ组），分别为29例、26例、11例。比较各组间上述参数的差异；分析左房应变参数与左房低电压区面积的相关性。结果 Ⅲ组CHA2DS2-VASc评分、陈旧性脑梗死或一过性脑缺血病史占比均较Ⅰ组、Ⅱ组增加，差异均有统计学意义（均P＜0.05＝。Ⅰ组与Ⅲ组、Ⅱ组与Ⅲ组E/e’＞14者占比比较，差异均有统计学意义（均P＜0.05＝；各组左房、左室大小参数、LVEF比较，差异均无统计学意义。Ⅲ组LASr、LAScd、LASct、LAEF均低于Ⅰ组和Ⅱ组，差异均有统计学意义（均P＜0.05＝；Ⅰ组与Ⅱ组各左房应变参数、LAEF比较，差异均无统计学意义。相关性分析显示，LASr、LAScd、LASct与左房低电压区面积均呈负相关（r=-0.538、-0.448、-0.501，均P＜0.05＝。结论 当左房低电压区程度达到10%时，左房结构虽未发生改变，但其功能已经减低，卒中患病率增加。三维斑点追踪技术可以早期发现非瓣膜性房颤患者左房低电压对左房功能的影响。 |
| 关键词: 超声心动描记术 斑点追踪 三维 心房颤动 应变 低电压区 |
| DOI： |
| 投稿时间：2023-11-28修订日期：2024-03-18 |
| 基金项目: |
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| Evaluating the effects of left atrial low voltage on left atrial function in patients with non-valvular atrial fibrillation by three-dimensional speckle tracking imaging[ABSTRACT] |
| zhouyixi,dulijuan |
| () |
| Abstract: |
| Objective To evaluate the effects of different degrees of left atrial low voltage on left atrial structure，function and clinical characteristics in patients with non-valvular atrial fibrillation （AF）. Methods Sixty-six patients with AF who underwent radiofrequency ablation were enrolled. Clinical data of patients were recorded before operation. Transthoracic echocardiography were performed to obtain the left atrial end-systolic diameter, left atrial end-systolic diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction (LVEF), and the ratio of early diastolic peak mitral flow to peak mitral annular velocity （E/ e ''）.The Left atrial reservoir phase strain (LASr), pipeline phase strain (LAScd), pump functional phase strain (LASct) and left atrial ejection fraction （LAEF） were collected by three-dimensional speckle tracking imaging technique. Left atrial low voltage area was obtained by three-dimensional electro-anatomical mapping during radiofrequency ablation. According to the percentage of low voltage area to left atrial surface area，the patients were divided into non-low voltage group（group I），the degree of left atrial LVA ＜ 10%（group II），and the degree of left atrial LVA ≥10%（group III）, 29 cases, 26 cases and 11 cases, respectively. The above parameters among the three groups were compared. The correlation between left atrial strain parameters and left atrial low voltage area was analyzed. Results The CHA2DS2-VASc score and the cerebral infarction or transient cerebral ischemia history in group Ⅲ were higher than those in group Ⅰ and group Ⅱ, and the differences were statistically significant（P＜0.05）. There were statistically significant differences in the proportion of E/e ''＞14 between group Ⅰ and group Ⅲ, group Ⅱ and group Ⅲ （P＜0.05）. There were no significant differences in left atrial and left ventricular size parameters and LVEF among the groups. LASr, LAScd, LASct and LAEF in group Ⅲ were lower than those in group Ⅰ and group Ⅱ, and the differences were statistically significant （P＜0.05）. There was no significant difference in left atrial strain parameters and LAEF between group Ⅰ and group Ⅱ. Correlation analysis showed that LASr, LAScd, LASct were negatively correlated with left atrial low voltage area. Correlation analysis showed that there was a significant correlation between the left atrial low voltage area and left atrial strain parameters（r=-0.538、-0.448、-0.501,P＜0.05）. Conclusion When the degree of LVA reaches 10%, the left atrial structure does not change, but its function is reduced and the incidence of stroke increases. Three-dimensional speckle tracking imaging technique can early detect the effect of left atrial low voltage on left atrial function in patients with nonvalvular atrial fibrillation. |
| Key words: Echocardiography Speckle tracking Three dimensional Atrial fibrillation Strain Low voltage area |
