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超声心动图及二维斑点追踪评估心房颤动对左心房形态及功能的影响

Using echocardiography and two-dimensional speckle tracking to evaluate the influence of atrial fibrillation on the shape and function of the left atrium

    摘要
  • 摘要:
    目的 应用超声心动图及二维斑点追踪技术评估非瓣膜病性房颤的左心房形态及功能变化，并探讨超声心动图参数对隐匿的阵发性房颤的辅助诊断价值。
    方法 顺序入组2020年7月24日至2020年8月5日复旦大学附属中山医院收治的非瓣膜病性房颤患者62例，根据行超声心动图检查时为窦性心律或房颤心律分为房颤窦律组（n=32）和房颤组（n=30），另选30例健康对照，在机测量左心房最大容积（left atrial maximum volume，LAVmax）、最小容积（left atrial minimum volume，LAVmin）、左心房排空分数（left atrial emptying fraction，LAEF）、左心房容积指数（left atrial volume index，LAVI），使用Qlab软件脱机测量左心房存储应变（left atrial reservoir strain，LASr）、通道应变（left atrial conduct strain，LAScd）、收缩应变（left atrial contraction strain，LASct）。
    结果 LAVmax、LAVmin、LAVI在对照组、房颤窦律组、房颤组逐渐增大，LASr则逐渐减小（均P < 0.05）；房颤窦律组和房颤组LAScd较对照组显著降低（P < 0.05），但房颤窦律组与房颤组间差异无统计学意义。LAVmin：截断值22.3 mL，灵敏度0.625，特异度0.889，AUC 0.793；LAScd：截断值-19.93%，灵敏度0.813，特异度0.852，AUC 0.826，LAVmin和LAScd对于阵发性房颤具有较好的诊断价值。LAEF：截断值62.95%，灵敏度0.741，特异度0.875，AUC 0.840；LASr：截断值32.73%，灵敏度0.889，特异度0.750，AUC 0.880，LAEF和LASr对于阵发性房颤具有较好的排除价值。
    结论 房颤窦律组、房颤组的左心房容积较对照组逐渐增大，LAEF及LASr则逐渐降低。超声评估的左心房形态及功能参数，尤其是LAVmin、LAScd、LAEF和LASr有助于窦性心律受检者阵发性房颤的诊断与排除。

     

    Abstract:
    Objective To evaluate the morphological and functional changes of the left atrium of non-valvular atrial fibrillation using echocardiography and two-dimensional speckle tracking (2D-STI), and to explore the value of echocardiographic parameters in the diagnosis of paroxysmal atrial fibrillation.
    Methods Sixty-two patients with atrial fibrillation of Zhongshan Hospital, Fudan University (32 patients with sinus rhythm during echocardiography as atrial fibrillation sinus rhythm group, AFsinus group; 30 patients with atrial fibrillation rhythm during the examination as atrial fibrillation group, AF group) and 30 healthy volunteers (control group) were enrolled sequentially from July to August 2020. Echocardiography was performed to measure left atrial maximum volume (LAVmax), minimum volume (LAVmin), volume index (LAVI), and left atrial emptying fraction (LAEF). 2D-STI was performed to measure left atrial reservoir strain (LASr), left atrial conduct strain (LAScd), and left atrial contraction strain (LASct).
    Results LAVmax, LAVmin, LAVI, and LASr showed gradient changes among the three groups (all P < 0.05). LAScd in the disease groups was significantly lower than that in the control group (P < 0.05), but there was no significant difference between the AFsinus group and the AF group. LAVmin: cut-off value 22.3 ml, sensitivity 0.625, specificity 0.889, AUC 0.793; LAScd: cut-off value -19.93%, sensitivity 0.8125, specificity 0.8519, AUC 0.826, LAVmin and LAScd have good diagnostic value for paroxysmal atrial fibrillation. LAEF: cut-off value 62.95%, sensitivity 0.741, specificity 0.875, AUC 0.840; LASr: cut-off value 32.73%, sensitivity 0.889, specificity 0.750, AUC 0.880, LAEF and LASr have good exclusion value for paroxysmal atrial fibrillation.
    Conclusions Left atrial volume increases progressively with the progression of atrial fibrillation, while the LAEF and LASr decrease progressively. The morphological and functional parameters of the left atrium evaluated by echocardiography, especially LAVmin, LAScd, LAEF, and LASr, are helpful in the diagnosis and elimination of paroxysmal atrial fibrillation in sinus rhythm subjects.

     

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