| 摘要: |
| 目的：应用二维斑点追踪技术(2D-STI)联合实时三维超声(RT-3DE)评估房颤(AF)合并中重度三尖瓣反流患者的右房功能,并探讨该类患者发生中重度三尖瓣反流的危险因素。方法：选择2023年1月至2023年11月于我院心内科住院并确诊的阵发性AF患者134例,其中AF合并轻度三尖瓣反流组(A组)患者共99例,AF合并中重度三尖瓣反流组(B组)患者35例,另选取同期健康者41例作为对照组。比较三组临床资料、常规超声心动图参数[右房左右径(RAD1)、右房上下径(RAD2)、三尖瓣瓣环直径(TVD)及三尖瓣瓣叶闭合高度(TVH)等]、2D-STI参数[右房储存期应变(RASr)、管道期应变(RAScd)及辅泵期应变(RASct)]和RT-3DE参数[右房最大容积指数(RAVImax)、最小容积指数(RAVImin)、收缩期前容积指数(RAVIpre)、被动排空分数(pasEF)及主动排空分数(actEF)]的差异。应用二元logistic回归分析探索AF合并中重度三尖瓣反流的危险因素,同时绘制ROC曲线分析其对该类患者的预测价值。结果：与对照组相比,A组RASr、RAScd、RASct、pasEF及actEF均降低,RAVImax、RAVImin及RAVIpre均增高,差异均具有统计学意义(均P＜0.05)；与对照组、A组相比,B组RASr、RAScd、RASct、pasEF及actEF均降低,RAVImax、RAVImin及RAVIpre均增高,差异均具有统计学意义(均P＜0.05)。多因素分析显示TVD、RASr及RAVImin是AF合并中重度三尖瓣反流的独立危险因素。ROC曲线分析显示TVD、RASr及RAVImin预测的曲线下面积分别为0.9、0.88和0.774。结论：房颤伴三尖瓣反流患者右房会发生结构与功能重塑,TVD、RASr及RAVImin是房颤患者发生中重度三尖瓣反流的独立危险因素。 |
| 关键词: 房颤 三尖瓣反流 右房 实时三维 |
| DOI： |
| 投稿时间：2024-02-06修订日期：2024-04-02 |
| 基金项目: |
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| Real-time three-dimensional ultrasound evaluation of right atrial function and risk factors for exacerbation of regurgitation degree in patients with functional tricuspid valve regurgitation |
| LiXinyi,ZhouChang,NieShuting,ShaoYuanyuan,HuWenshu,Shendian,ZhangAoyi |
| () |
| Abstract: |
| Objective: Two-dimensional spot tracking (2D-STI) combined with real-time three-dimensional ultrasound (RT-3DE) was used to evaluate the right atrial function in patients with atrial fibrillation (AF) combined with moderate and severe tricuspid regurgitation, and to explore the risk factors for the occurrence of moderate and severe tricuspid regurgitation in these patients. Methods: A total of 134 patients with paraphylaxis AF who were admitted and diagnosed in the Department of Cardiology of our hospital from January 2023 to November 2023 were selected, including 99 patients with mild tricuspid valve regurgitation (Group A), 35 patients with moderate and severe tricuspid valve regurgitation (group B), and 41 healthy patients in the same period as the control group. Clinical data, conventional echocardiographic parameters [right atrium diameter (RAD1), right atrium diameter (RAD2), tricuspid annulus diameter (TVD) and tricuspid lobe closure height (TVH), etc.], 2D-STI parameters [right atrium storage strain (RASr), duct stage strain (RAScd) and auxiliary pump stage strain (RASct) were compared among the three groups. ] and RT-3DE parameters [right atrial maximum volume index (RAVImax), minimum volume index (RAVImin), pre-systolic volume index (RAVIpre), passive emptying score (pasEF) and active emptying score (actEF)]. Binary Logistics regression analysis was applied to explore the risk factors of AF combined with moderate and severe tricuspid regurgitation, and ROC curve was drawn to analyze the predictive value of independent risk factors for these patients. Results: Compared with control group, RASr, RAScd, RASct, pasEF and actEF in group A were decreased, RAVImax, RAVImin and RAVIpre were increased, the differences were statistically significant (all P < 0.05). Compared with control group and group A, RASr, RAScd, RASct, pasEF and actEF in group B were decreased, while RAVImax, RAVImin and RAVIpre were increased, with statistical significance (all P < 0.05). Multivariate analysis showed that TVD, RASr and RAVImin were independent risk factors for AF with moderate and severe tricuspid regurgitation. ROC curve analysis showed that the areas under the curve predicted by TVD, RASr and RAVImin were 0.9, 0.88 and 0.774, respectively. Conclusion: Right atrium remodeling occurs in patients with atrial fibrillation and tricuspid regurgitation. TVD, RASr and RAVImin are independent risk factors for moderate to severe tricuspid regurgitation in patients with atrial fibrillation. |
| Key words: atrial fibrillation tricuspid regurgitation atrium dextrum real time three-dimensional echocardiography |
