环肺静脉电隔离术后阵发性房颤患者左心耳结构及功能的超声评价

目的应用经食管超声心动图(TEE)评价阵发性房颤患者行环肺静脉电隔离术(CPVA)后左心耳(LAA)结构和功能的变化。方法对43例首次行CPVA术的阵发性房颤患者,留取CPVA术前1周内及术后24~48h、3个月常规经胸及经食管超声图像进行分析,经胸测量左心房前后径、左右径及上下径(LADap、LADml、LADsi);经食管测量左心耳最大峰值排空速度(LAA-PEV)、最大峰值充盈速度(LAA-PFV)、左上肺静脉界脊宽度(LAA-RW);描记左心耳舒张末期面积(LAA-EDA)、收缩末期面积(LAA-ESA),并计算左心耳射血分数(LAA-EF);记录左心耳自发性超声显影(LAA-SEC)现象。结果与术前相比,术后24~48hLAA-EF有减小的趋势,但差异无统计学意义(P0.05);术后3个月LAA-EF明显增加(P0.05);术后24~48h、3个月LAA-PEV、LAA-PFV有增加的趋势,但差异无统计学意义(P0.05)。与术前相比,术后24~48hLAA-RW明显增加(P0.05);术后3个月LAA-RW无明显差异(P0.05)。43例患者中,术前左心耳自发性超声显影(LAA-SEC)3例(6.98%);术后24~48hLAA-SEC 5例(11.63%);术后3个月LAA-SEC 1例(2.33%)。结论 CPVA术后阵发性房颤患者左心耳收缩功能逐渐得到改善。CPVA术短期内对左心耳、肺静脉界脊造成一定损伤。TEE可作为评价CPVA术后左心耳结构和功能的一种准确、有效的检查方法。     

经食管实时三维超声对心房颤动患者左心耳功能与血栓形成的研究

目的应用经食管实时三维超声心动图(RT-3DTEE)研究心房颤动(AF)患者左心耳(LAA)功能与血栓形成之间的关系。方法选取145例经RT-3DTEE检查的患者分为三组,对照组、房颤无血栓组及房颤血栓组,测量LAA多项指标进行统计学分析。结果 (1)房颤组LAA-D、LAA-Vmax及LAD均较对照组增加,LAA-EV、LAA-FV及LAA-EF均较对照组减小,差异有统计学意义(均P0.05)。(2)Logistic回归分析发现LAA-EV、LAA-FV及LAA-EF是房颤合并血栓形成的独立危险因素(均P0.05)。(3)ROC曲线分析LAA-EV、LAA-FV及LAA-EF预测LAA血栓发生的截断值分别为30.35、26.2cm/s及29%。结论 RT-3DTEE通过评估LAA功能,可以预测房颤患者左心耳血栓形成的风险,为临床提供准确可靠的信息。     

房颤患者术前二尖瓣反流程度与射频消融术后复发的相关性研究

目的 心房颤动(AF)患者常合并MR,但二尖瓣反流程度与导管消融(CA)结果之间的关系尚不清楚。本研究阵发性房颤患者术前二尖瓣反流程度与射频消融术后复发房颤的相关性。方法 选择首次射频消融术治疗患者阵发性房颤患者274例,收集包括临床特征、术前超声心动图参数、二尖瓣功能参数等,采用Logistic回归法分析术前二尖瓣反流程度与射频消融术后复发的相关性。结果(1) 274例行射频消融治疗的阵发性房颤患者中,射频术前二尖瓣无反流患者172例(62.77%),轻度反流72例(26.28%),中度反流21例(7.66%),重度反流9例(3.28%);(2)不同程度的二尖瓣反流患者在脑卒中史、吸烟史、LAD、LAV、LVESD、EF、消融术后复发率等,差异有统计学意义(P<0.05);Logistic回归分析显示二尖瓣反流、LAD是房颤射频消融术后复发独立因素(P<0.05或P<0.01),在未调整、初步调整以及充分调整协变量后显示,二尖瓣反流程度的加重增加了房颤射频消融术后复发风险。结论术前二尖瓣反流程度是房颤射频术后复发的危险因素,并且术后复发风险随着二尖瓣反流程度的加重而增加,提示可能是预测房颤射频消融术后复发的因子。     

经食管超声联合斑点追踪技术对房颤射频消融术后复发的预测研究

目的 应用经食管超声联合斑点追踪成像技术评估房颤患者射频消融术后复发的预测研究。方法 初次行经导管射频消融术的阵发性房颤(PAF)患者269例,按临床随访结果分为复发组79例、成功组190例。应用经食管超声(TEE)测量左心耳血流速度(LAA-v),常规测量左心房前后径(LAD)、左心房容积指数(LAVI)及CAAP-AF评分,二维斑点追踪成像技术(2D-STI)测量左心房储器期应变(LASr)、左心房管道期应变(LAScd)、左心房泵期应变(LASct),比较各参数与复发的相关性。结果 Logistic回归分析提示左心房储器期应变、左心耳血流速度是阵发性房颤预测射频消融术后复发的敏感指标。结论 超声参数可以多指标联合筛选术后易复发的患者,为临床治疗提供参考降低手术复发率。     

左房容积指数用于预测心房颤动患者射频消融后复发的meta分析

目的 评价左房容积指数(left atrial volume index,LAVI)用于预测心房颤动(atrial fibrillation,AF)患者射频消融术后复发的临床价值。方法 计算机检索PubMed、the Cochrane Library、Web of Science、中国知网、中国生物医学文献数据库、维普数据库等,查找LAVI用于预测AF患者射频消融后复发的相关文献。采用STATA 12.0进行meta分析。结果 共纳入13项研究1 519例AF患者。Meta分析结果显示与AF射频消融后未复发患者相比,复发患者平均LAVI更高(SMD=2.51, 95%CI:1.61～3.41,P=0.001),同时AF射频消融后未复发患者与复发患者LAV/LAVI两组间差异有统计学意义(OR=2.88,95%CI:2.68～3.10,P=0.001),提示AF患者接受射频消融术后密切监测LAVI变化可有效评估其术后复发的可能性。结论 与AF射频消融术后未复发的患者相比,复发的患者平均LAVI更高,其可作为评估AF患者接受射频消融术后复发的有效指标。结论仍需更多多中心、大样本的随机对照试...     

右房容积指数在射频消融手术联合心腔内电复律治疗持续性心房颤动及其远期复发中的应用价值

目的分析右房容积指数(RAVI)在经导管射频消融术联合心腔内电复律治疗持续性心房颤动(AF)及其远期复发中的应用价值。方法选取在我院行多步骤递进式消融(包括环肺静脉隔离+线性隔离+碎裂电位消融)后,AF仍未终止,术中再行心腔内电复律治疗的持续性AF患者66例。将术前7d内和术后12~48个月的超声心动图及临床资料进行对比研究,尤其对RAVI进行重点分析。结果所有患者术后均转复为窦性心律。根据是否远期复发,将患者分为复发组(23例)和未复发组(43例)。复发组的RAV、RAVI和AF病程均显著高于未复发组(P0.05),两组间差异有统计学意义。LVMI、LAV、LAVI在两组间差异无统计学意义(P0.05)。两组患者的临床资料比较差异均无统计学意义(P0.05)。结论经导管射频消融术联合心腔内电复律可将持续性AF成功转为窦性心律。RAVI可反映持续性AF术后RA结构的改变。     

慢性房颤患者射频消融术后左心房和左心室远期结构变化

目的探讨慢性房颤患者射频消融术后左心房、左心室远期结构变化。方法 50例经射频消融治疗的房颤患者根据复发情况分为复发组(n=18)与未复发组(n=32),对比两组患者术前、术后12个月左房前后径、左右径、上下径,左心房最大容积、左心室舒张末期内径、左心室收缩末期内径、左室射血分数。结果术前、术后随访12个月比较左房前后径、左右径、上下径,左心房最大容积、左心室舒张末期内径、左心室收缩末期内径、左室射血分数比较,复发组差异无统计学意义(P0.05),未复发组差异具有统计学意义(P0.05)。结论射频消融术治疗房颤具有显著疗效,复律并维持窦性心律对于逆转左心房、左心室重构,提高左室功能均具有重要意义。     

血清半乳糖凝集素3水平与房颤患者射频消融术后复发的相关性

【目的】探讨半乳糖凝集素3(Gal-3)与房颤患者射频消融术后复发的相关性。【方法】选择2016年6月至2018年6月延安大学咸阳医院心内科收治的90例行射射频消融术治疗的房颤患者的临床资料,根据术后是否复发将其分为复发组(n=27)和未复发组(n=63)。采用夹心酶联免疫吸附荧光法检测血清Gal-3浓度,采用COX回归模型分析血清Gal-3水平对房颤消融术后复发的影响。【结果】90例房颤患者中持续性房颤48例(53.3%),24.4%的患者CHA2DS2-VASC评分>2分,在抗凝药物的使用上以华法林为主(60.0%)。复发组与未复发组患者年龄、房颤类型XHA2DS2-VASC评分、左心房直径(LAD)及血清氨基末端B型脑钠肽前体(NT-proENP)、高敏C反应蛋白(hs-CRP)、Gal-3水平比较,差异均有统计学意义(P<0.05)。单因素COX回归分析显示,年龄、LAD、持续性房颤及血清Gal-3、hs-CRP水平是房颤患者术后复发的危险因素(P<0.05)。多因素COX回归进一步分析显示,持续性房颤、LAD及血清Gal-3、hs-CRP水平是房颤患者RFCA术后复发的独立危险因素(P<0.05)。【结论】血清Gal-3水平是房颤患者行RFCA术后复发的独立危险因素,血清Gal-3高者复发风险大。     

血清Hcy和BNP水平对心房颤动患者射频消融术后复发的预测价值

目的:探究血清同型半胱氨酸(homocysteine,Hcy)、脑钠肽(brain natriuretic peptide,BNP)水平对心房颤动(atrial fibrillation,AF)患者射频消融术后复发的预测价值。方法:选择2016年1月至2018年10月成都市龙泉驿区第一人民医院心内科收治的95例AF患者为AF组,选择同期体格检查健康的成年人为对照组。两组受试者均于入院后测定血清Hcy和BNP水平,AF组接受射频消融术后进行为期12个月的随访,统计复发情况,分析AF患者复发的危险因素及血清Hcy和BNP的预测价值。结果:AF组患者血清Hcy和BNP水平显著高于对照组受试者(P0.05)。AF患者术后随访复发32例,复发率为33.68%;经比较,复发组患者高血压、糖尿病比例显著高于未复发组(P0.05);左心房直径、血清Hcy和BNP水平显著高于未复发组,差异具统计学意义(P0.05)。Logistic多因素分析示:在矫正其他影响因素后,高血清Hcy和BNP水平是AF患者射频消融术术后复发的独立危险因素(P0.05)。血清Hcy和BNP预测复发的曲线下面积(area under the area,AUC)分别为0.774,0.828,预测最佳截点值分别为2 5.7μmol/L, 7 8.4p g/mL;两者联合预测复发的曲线下面积为0.865。结论:血清Hcy和BNP水平与AF患者射频消融术后复发相关,临床可根据截点值筛选复发高风险人群,进行病情检测及早期干预。     

P波离散度与阵发性房颤经导管射频消融术后复发的关系

目的：探讨P波离散度与阵发性房颤经导管射频消融术后房颤复发的关系。方法：78例初次行导管射频消融治疗的阵发性房颤患者,消融术式为电解剖标测系统加单环状标测电极指导下的环肺静脉线性消融术。测量术前体表心电图各导联的P波时限,计算P波离散度。结果：术后随访32．9±4．8个月,有效组64例,复发组14例。复发组术前的P波离散度（46．2±11．8ms）较有效组（37．4±14．2ms）大（P〈0．05）。若以40ms为界值,术前P波离散度预测术后房颤复发的敏感性为86％,特异性为59％。其他的临床及心电图指标在两组间无显著差异。结论：经导管射频消融治疗阵发性房颤的疗效肯定,复发组患者术前的P波离散度明显大于非复发组,术前P渡离散度对术后房颤的复发有一定预测价值。     

Relationship between left atrial appendage emptying and left atrial function using cardiac magnetic resonance in patients with atrial fibrillation: comparison with transesophageal echocardiography

To compare cardiac magnetic resonance (CMR) quantifications of left atrium (LA) function and left atrial appendage (LAA) emptying depending on the presence of LA spontaneous echogenic contrast (LA-SEC) on transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF). A total of 48 patients with AF underwent sequential CMR examination and TEE in preparation for catheter ablation. The CMR protocol included cine and velocity encoding (VENC) sequences for evaluation of both LA function and LAA emptying. The peak blood velocity of LAA just before left ventricle systole was defined as the LAA emptying velocity (LAA-EV). Depending on the presence of LA-SEC on TEE, patients were divided into two groups, the SEC group (n?=?15) and the non-SEC group (n?=?33). Mean LAA-EV was significantly greater in the non-SEC group than in the SEC group (54.5?±?24.8 ml/s vs. 26.0?±?22.6 ml/s, P?<?0.01). LAA-EV had a significant positive relationship (P?<?0.05) with LAA backflow velocity, as assessed using TEE. Use of an optimal LAA-EV cutoff value of 35 ml/s to predict LA-SEC yielded a sensitivity of 80.0?%, a specificity of 75.7?%, and positive and negative predictive values of 58.8 and 83.9?%, respectively. Using VENC-CMR, LAA-EV is associated with LA function and can be useful for predicting LA-SEC in patients with AF.     

经食管实时三维超声心动图评估心房颤动患者左心耳结构及其与血栓形成的相关性

目的应用经食管实时三维超声心动图（RT-3D TEE）评估心房颤动患者左心耳（LAA）形态及排空分数,同时分析LAA血栓形成的独立危险因素。 方法选择2015年1月至2017年1月在广东省珠海市人民医院行RT-3D TEE检查的90例患者。其中53例心房颤动患者（AF组）,37例非心房颤动患者（NAF组）。53例AF组患者中,11例患者LAA内血栓（血栓组）,13例患者LAA自发显影（自发显影组）,29例患者LAA未见异常（未见异常组）。采用RT-3D TEE测量并计算所有患者LAA分叶数、排空分数、开口宽度指数（LAA-WI）、长度指数（LAA-LI）、开口面积指数（LAA-OI）、最大容积指数（LAA-VImax）、最小容积指数（LAA-VImin）、射血分数（LAA-EF）、排空血流速度（LAA-v）、左心房最大容积指数（LA-VImax）。采用方差分析比较血栓组、自发显影组、未见异常组及NAF组患者LAA分叶数,进一步组间两两比较采用LSD-t检验;采用t检验分别比较AF组和NAF组患者二维面积法、三维面积法和三维容积法测量的LAA排空分数;采用t检验比较血栓组或自发显影组与未见异常组患者年龄、LAA-WI、LAA-LI、LAA-OI、LAA-VImax、LAA-VImin、LAA-EF、LAA-v、LA-VImax及LAA分叶数差异;采用Logistic回归分析分析LAA血栓形成的独立危险因素。 结果血栓组、自发显影组、未见异常组、NAF组患者LAA平均分叶数分别为（3.57±0.77）、（3.28±0.99）、（2.57±0.68）、（2.76±1.13）叶。血栓组患者LAA平均分叶数较自发显影组、未见异常组、NAF组患者增多,且与NAF组比较差异有统计学意义（t=2.294,P<0.05）;而其余任意两组间差异均无统计学意义。AF组患者二维面积法、三维面积法和三维容积法测量的LAA排空分数均低于NAF组患者,且差异均有统计学意义（t=8.671、7.082、10.432,P均<0.05）。血栓组或自发显影组患者LAA-WI、LAA-OI、LAA-VImax、LAA-VImin、LA-VImax及LAA分叶数均大于未见异常组患者[（18.27±2.14）mm/m² vs （12.76±1.93）mm/m²,（3.45±0.46）cm²/m² vs （2.64±0.37） cm²/m²,（6.63±0.73）ml/m² vs （4.72±0.48）ml/m²,（4.22±0.53）ml/m² vs （2.51±0.22）ml/m²,（4.57±0.32）ml/m² vs （4.21±0.28）ml/m²,（3.62±0.11）叶vs （2.57±0.08）叶],LAA-EF、LAA-v均小于未见异常组患者[（34.12±2.31）% vs （48.09±2.74）%,（29.11±1.08）cm/s vs （48.18±2.11）cm/s],且差异均有统计学意义（t=9.849、7.107、11.000、14.787、4.367、40.471、19.814、42.417,P均<0.001）;而年龄、LAA-LI差异均无统计学意义。Logistic回归分析结果表明,LAA排空分数是LAA血栓或自发显影形成的独立危险因素（OR=2.323,95%CI：1.471-2.821）。 结论RT-3D TEE评估LAA复杂结构可行且准确性更高。LAA分叶数增多、排空功能减低与LAA血栓形成相关,且LAA排空分数降低是LAA血栓形成的独立危险因素。     

房颤患者左心耳血栓形成与结构功能的关系

目的 分析房颤患者血栓形成与左心耳结构功能的关系。方法 采用经食管超声心动图检测88例房颤患者及18例对照组患者的左心腔前后径(LA-D)、左心耳入口宽度(LAA-W)、左心耳长度(LAA-L)、左心耳前壁、后壁及顶部的运动速度及左心耳充盈及排空速度等指标。根据左心耳内透声,将房颤患者分为无自发显影(NO SEC)亚组、自发显影(SEC)亚组、泥浆样改变(sludge)亚组和血栓(thrombosis)亚组,并将各指标与对照组进行比较。结果 与对照组相比,房颤组患者左心耳结构及功能均有不同程度的改变;sludeg亚组及thrombosis亚组的LAA-W均较对照组增大,差异有统计学意义(P均<0.05);血栓亚组的LAA-L较对照组增大,差异有统计学意义(P<0.01);房颤各亚组的LA-D均较对照组扩大(P均<0.05);房颤各亚组的左心耳充盈及排空速度均较对照组降低(P均<0.05),在血栓亚组降低更为明显;除无自发显影亚组外,余各亚组的左心耳各壁运动速度差异均有统计学意义(P均<0.01)。结论 房颤患者左心耳内血栓形成与左心耳的结构以及功能改变密切相关。     

Recurrence of symptomatic atrial fibrillation after successful catheter ablation of atrioventricular accessory pathways: a multivariate regression analysis

The primary aim of this study is to investigate the factors related to the recurrence of atrial fibrillation (AF) after a successful ablation of atrioventricular accessory pathway. Thirty-seven patients with spontaneous AF (study group) were selected from 401 consecutive patients who underwent radiofrequency catheter ablation of atrioventricular accessory pathway. A multivariate regression analysis was used in order to evaluate the relationships between AF recurrence and patients' age, sex, atrial size, left ventricular function, location of accessory pathways, heart rate during atrioventricular re-entrant tachycardia and atrial vulnerability (induction of sustained AF) after a successful ablation. Atrioventricular accessory pathway was abolished in 36 of the study group patients and 351 of the control group patients. During the follow-up of 36 +/- 11 months, four patients (11.1%) from the study group experienced sustained AF. Multivariate regression analysis showed that, in patients with pre-ablation AF, older age and post-ablation atrial vulnerability were the only independent predictive factors for AF recurrence. We concluded that radiofrequency catheter ablation of atrioventricular accessory pathway greatly reduces the risk of AF in patients who had a history of symptomatic AF. Older patients and patients with inducible AF after accessory pathway ablation are at an increased risk of AF recurrence. These patients should be closely monitored after successful ablation of atrioventricular accessory pathways.     

A novel predictive model for late recurrence after catheter ablation for atrial fibrillation using left appendage volume measured by cardiac computed tomography

Larger left atrial appendage (LAA) volume is associated with a higher risk of late recurrence (LR) in patients undergoing radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, it is unclear whether LAA volume predicts LR, independent of established risk factors. We sought to evaluate the value of LAA volume in predicting LR after RFCA for AF and to develop a score prediction model including LAA volume for these patients. We retrospectively studied 992 patients who underwent RFCA for AF and cardiac computed tomography before RFCA at a single center. At 3 years after RFCA, 362 patients (36.5?%) experienced recurrence. The multivariate Cox regression model showed that age?≥?75 years (10 points), non-paroxysmal AF (9 points), diabetes mellitus (4 points), left atrial volume index (1 point per 10 ml/m² rounded to the nearest integer), and the second (4.7 to < 7 ml/m²; 4 points) and third (≥?7 ml/m²; 5 points) tertiles of the LAA volume index were independent risk factors LR. The above-mentioned risk factors were included in the integrated score model, and the C-index of the proposed score model was 0.715 (95?% confidence interval [CI] 0.679–0.752). LAA volume is an independent predictor of LR and the predictive model including LAA volume showed good discrimination power. These findings provide evidence for the inclusion of LAA volume in the risk stratification for AF recurrence in patients undergoing RFCA for AF.

     

阵发性房颤环肺静脉电隔离术前后左房结构和功能的研究

目的经胸超声心动图(TTE)和经食道超声心动图(TEE)联合应用对阵发性房颤患者肺静脉前庭电隔离术前后左房、左心耳结构和功能的评价。方法46例阵发性房颤患者和16例正常对照组接受TTE和TEE检查,测量左房内径指数(LADI)、左房面积指数(LAAI)、左房容积指数(LAVI)、左房射血力(LA-EF)、左心耳内径指数(LAADI)、左心耳最大面积指数(LAAmaxI)、左心耳最小面积指数(LAAminI)、左心耳射血分数(LAA-EF)、左心耳最大排空血流速度(LAA-P)和左心耳最大充盈血流速度(LAA-F)及有无血栓征象。41例确诊无左心房及左心耳血栓的患者行肺静脉前庭电隔离术。术后6个月以上对其中39例患者随访行TTE和TEE复查。结果肺静脉前庭电隔离术组、术后随访组与正常对照组间左房结构、功能均有显著差异(P<0.05～P<0.01)。三组间左心耳的结构和功能亦均有显著差异(P<0.05～P<0.01)。阵发性房颤患者左房、左心耳结构与其功能的变化呈线性负相关。结论TTE和TEE联合应用为评价阵发性房颤患者左房的结构、功能以及肺静脉前庭电隔离术前病例的筛选、术后疗效的评估提供重要信息。     

Double-contrast,single-phase computed tomography angiography for ruling out left atrial appendage thrombus prior to atrial fibrillation ablation

Prior to atrial fibrillation (AF) ablation, computed tomography angiography (CTA) is increasingly used for left atrial appendage (LAA) thrombus detection. LAA filling defects on CTA may represent thrombus or incomplete contrast mixing with blood. A pre-bolus of contrast material with delay before the CTA contrast bolus can help distinguish between thrombus and incomplete contrast mixing. We present results from a double-contrast, single-phase CTA protocol used in our daily clinical practice. In patients who underwent AF ablation between 2011 and 2015, double-contrast, single-phase CTA was performed prior to ablation. Two contrast boluses (30 and 70 ml) with 25-s interbolus delay were administered followed by prospectively triggered cardiac CTA. Only patients with left atrial (LA) or LAA filling defects underwent transesophageal echocardiography (TEE) to rule out thrombus. Prior to ablation, 605 CTA-scans were performed (median radiation dose: 3.1 mSv). In 579 CTA-scans (95.7?%), the LA and LAA completely filled with contrast. In 26 CTA-scans (4.3?%) the LAA showed a filling defect whereby thrombus could not be excluded. In 2 of those 26 patients (7.7?% and 0.3?% of the total population), TEE verified LAA thrombus. Low-risk LAA filling defects on CTA (n?=?7/26) with an inhomogeneous aspect, Houndsfield Unit values >100, and an indefinite border were all caused by incomplete contrast mixing. No thromboembolic complications occurred perioperatively or during 6 months follow-up. Prior to AF ablation, incidence of LAA filling defects on double-contrast, single-phase CTA is low. TEE remains warranted in all but low-risk filling defects to rule out thrombus.     

Left atrial appendage: morphology and function in patients with paroxysmal and persistent atrial fibrillation

The anatomical and functional characteristics of the left atrial appendage (LAA) and its relationships with anatomical remodeling and ischemic stroke in patients with atrial fibrillation (AF) have not been clearly established. The purpose of this study was to determine whether functional and morphological features of the LAA independently predict clinical outcome and stroke in patients with AF who underwent catheter ablation (CA). Two hundred sixty-four patients with AF, including 176 with paroxysmal AF (PAF, 54.0 ± 11.4 years old, M:F = 138:38) and 88 with persistent AF (PeAF, 56.4 ± 9.6 years old, M:F = 74:14) were studied. Of these patients, 31 (11.7 %) had a history of stroke/TIA (transient ischemic attack). The LA and LAA volumes were 124.0 ± 42.4 and 24.9 ± 4.3 ml in PeAF, these values were greater than those in PAF (81.2 ± 24.8 ml and 21.2 ± 5.1 ml, P < 0.001). The AF type (P = 0.016) and AF duration (P = 0.005), and anti-arrhythmic drugs use (P < 0.001) were significant predictors of AF recurrence after CA in all patients. Compared with patients without history of stroke, stroke patients had larger LA volume (106.9 ± 23.0 vs. 94.0 ± 38.9 ml, P = 0.004) and had lower LAA EF (50.0 ± 11.0 vs. 65.7 ± 13.4 %, P < 0.001). The independent predictors of stroke were age (P = 0.002) and LAA EF (P < 0.001) in PAF patients and that was only age (P = 0.001) in PeAF patients. In anatomical and morphological parameters of the LA and LAA, only depressed systolic function of the LAA was significantly related to stroke/TIA and recurrence of AF after CA in paroxysmal AF patients. Further large scaled prospective study is required for validation.     

多普勒组织成像对心房纤颤射频消融治疗前后心房肌运动速度、应变及应变率变化的研究

目的探讨定量多普勒组织成像技术(DTI)在心房纤颤患者行射频消融(RFCA)治疗前后心房肌组织运动变化的特点。方法在15例正常体检者(对照组)及26例心房纤颤患者(AF组),RFCA术后3个月AF复发组及维持窦性心律组,应用DTI技术观察左心房侧壁、左心房后壁、左心房前壁、右心房游离壁、房间隔中部收缩期最大心肌运动速度、应变和应变率,以及左心耳入口处峰值血流速度(充盈峰速度和排空峰速度)的变化。结果 AF组左心房内径与对照组相比明显增大(P0.01);左心耳排空速度及其时间速度积分明显降低(P0.05);心房肌局部应变、应变率在收缩期峰值明显减低(P0.01);心房肌运动速度除右心房游离壁外,余部位均明显降低(P0.01)。RFCA术后3个月维持窦性心律组、AF复发组与对照组比较,左心房内径的改变具有统计学意义(P0.05或P0.01),左心耳排空峰值流速明显增高(P0.05);维持窦性心律组与AF复发组比较,收缩期峰值速度有所增加,但没有统计学意义(P0.05),应变和应变率明显增大并且具有统计学意义(P0.05或P0.01)。结论 AF患者RFCA术后左心耳血流排空速度、心房应变和应变率较高者具有较大的维持窦性心律的可能性;窦性心律的维持与左心房内径明显减小有关。     

经胸二维及三维超声心动图观察心房颤动患者左心房及肺静脉结构改变

目的 应用经胸二维及三维超声心动图观察心房颤动(房颤)患者左心房及肺静脉结构改变.方法 对126例患者进行检查,其中窦性心律(窦律)组64例,房颤组62例,房颤组依据病史进一步分为阵发房颤组及非阵发房颤组.首先进行二维超声检查,测量并计算左心房前后径(LAD)、左心房面积(LAA)、左心房容积(LAV).应用三维全容积显像测量肺静脉直径.结果 房颤组4支肺静脉直径较窦律组明显增宽,差异具有统计学意义(P＜0.05);在房颤患者中,非阵发房颤组4支肺静脉直径显著大于阵发房颤组(P＜0.05).窦律组、阵发房颤组、非阵发房颤组组内各支肺静脉比较,差异均无统计学意义(P＞0.05).房颤组与窦律组比较、非阵发房颤组与阵发房颤组比较,LAD、LAA、LAV明显增大(P＜0.05).结论 房颤患者心房增大,肺静脉增宽,非阵发房颤患者肺静脉增宽更明显.经胸二维及三维超声心动图町以无创观察房颤患者左心房及肺静脉结构改变.