心房颤动患者复律后心房顿抑与脑利钠肽的研究

目的:通过对心房颤动(房颤)患者复律后心房超声检查及血浆脑利钠肽(BNP)的检测,探讨心房顿抑与BNP的关系。方法:将76例房颤患者分为阵发性房颤组(40例)和持续性房颤组(36例),另入选对照组患者20例。在房颤复律后2h、1d、1周和1个月时经胸壁超声心动图(TTE)检查测定舒张晚期血流速度(A峰)和心房充盈分数(AFF),以A峰<50cm/s作为心房顿抑的标准,并测定上述时间点及复律前血浆BNP。结果:阵发性房颤组复律后2h心房顿抑的发生率为45.0%,复律后A峰和AFF至1周时恢复正常;持续性房颤组复律后2h左房顿抑的发生率为61.6%,A峰和AFF至1个月时恢复正常。2组复律后1d和1周时BNP与A峰有显著的相关性,在房颤复律后1d和1周时仍然存在心房顿抑的患者BNP显著高于无顿抑发生的患者(P<0.01),心房顿抑消失后,BNP迅速下降。结论:房颤复律后1d和1周时血浆BNP水平与跨二尖瓣A峰有相关性,较高的血浆BNP可能提示心房顿抑的持续存在,有助于了解左心房功能恢复情况。

Correlation between plasma brain natriuretic peptides and atrial stunningin patients with atrial fibrillation after cardioversion

Objective:To explore the relationship of atrial stunning and plasma brain natriuretic peptide(BNP) by detecting atrial function of heart ultrasound and testing plasma levels of BNP in patients with atrial fibrillation(Af) after cardioversion. Method:We selected 76 patients who were divided into paroxysmal Af(40 cases) and persistent Af(36 cases),and other 20 patients without Af as control.In patients with Af after cardioversion 2 hours,1 day,1 week and 1 month,we took transthoracic echocardiography(TTE) to measure late diastolic flow velocity(A peak) and atrial filling fraction(AFF).A peak <50 cm/s as atrial stunning standards,and test plasma BNP before and after cardioversion. Result:In paroxysmal Af group,the incidence of atrial stunning after cardioversion 2 hours was 45.0%,the level of A peak and AFF went back to normal in 1 week.In patients Af group,the incidence of atrial stunning after cardioversion 2 hours was 61.6%,the level of A peak and AFF went back to normal in 1 month.The level between A peak and plasma BNP had a significant correlation after cardioversion 1 day and 1 week in Af groups.Moreover,remaining atrial stunning after cardioversion 1 day and 1 week,the level of plasma BNP was significantly higher than patients withont atrial stunning(P<0.01).BNP decreased rapidly with the disappearance of atrial stunning. Conclusion:Plasma BNP is correlated with A peak after cardioversion 1 day and 1 week of Af.The higher plasma BNP could cue the continuity of atrial stunning.Testing plasma BNP could help to estimate left atrial function.