左心房追踪技术评价高血压心房颤动和孤立性心房颤动患者左心房功能

目的应用左心房追踪技术(LAVT)评价高血压心房颤动(房颤)和孤立性房颤患者左心房功能。方法实验组为50例房颤患者,分为孤立性房颤组24例,高血压房颤组26例,对照组为25例健康成人,用M型超声测量左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、舒张末期室间隔厚度(IVSTd)、舒张末期左心室后壁厚度(LVPWTd),用校正立方体积法(Teich)计算左心室射血分数(LVEF);二维超声测量患者收缩末期左心房前后径(LAD1)、上下径(LAD2)、横径(LAD3),收缩末期右心房上下径(RAD1)、横径(RAD2),应用LAVT测量左心房最大面积(LAAmax)、左心房最大容积(LAVmax)、最小容积(LAVmin)、收缩期左心房充盈速率峰值(dv/dtS)、舒张早期左心房排空速率峰值(dv/dtE)及舒张晚期左心房排空速率峰值(dv/dtA),并计算左心房排空分数(LAEF)。比较左心房的收缩及舒张功能。结果孤立性房颤组LAD1:(42.43±4.24)mm、LAD2:(60.22±5.79)mm、LAD3:(47.90±4.86)mm、RAD1:(55.04±5.06)mm、RAD2:(43.25±2.56)mm、LAAmax、LAVmax、LAVmin、dv/dtE与正常对照组LAD1:(33.81±2.96)mm、LAD2:(47.29±6.79)mm、LAD3:(39.04±3.53)mm、RAD1:(44.34±4.12)mm、RAD2:(36.06±3.16)mm、LAAmax、LAVmax、LAVmin、dv/dtE比较均明显升高(均为P<0.05),孤立性房颤组LAEF、dv/dtS、dv/dtA与正常对照组比较均明显减低(均为P<0.05),LVEDD、LVESD、IVSTd、LVPWTd、LVEF与正常对照组比较差异均无统计学意义(均为P>0.05)。与正常对照组比较,高血压房颤组的LAD1:(45.47±7.33)mm、LAD2:(61.35±7.39)mm、LAD3:(49.27±5.25)mm、RAD1:(56.18±4.36)mm、RAD2:(45.13±3.21)mm、LAAmax、LAVmax、LAVmin、dv/dtE均明显升高,LAEF、dv/dtS、dv/dtA均明显减低(均为P<0.05),LVEDD、LVESD、IVSTd、LVPWTd、LVEF差异均无统计学意义(均为P>0.05)。与孤立性房颤组相比,高血压房颤组LAAmax、LAVmax、LAVmin均明显升高(均为P<0.05),LAEF、dv/dtS、dv/dtE、dv/dtA均明显减低(均为P<0.05),LVEDD、LVESD、IVSTd、LVPWTd、LVEF、LAD1、LAD2、LAD3、RAD1、RAD2差异均无统计学意义(均为P>0.05)。结论 AF患者左心房功能明显下降高血压房颤患者左心房功能损害较孤立性房颤患者明显。LAVT能准确、快速的反映房颤患者左心房大小及功能的变化,在评价左心房功能方面有较高的重复性。

Evaluation of left atrial function with left atrial volume tracking method in patients with hypertensive atrial fibrillation and lone atrial fibrillation

Objective To evaluate the changes of left atrial(LA) function in patients with hypertensive atrial fibrillation and lone atrial fibrillation using left atrial volume tracking(LAVT) method.Methods Fifty patients with atrial fibrillation were divided into lone atrial fibrillation group(n=24) and hypertensive atrial fibrillation group(n=26).Twenty-five normal volunteers served as control group.Left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),interventricular septum thickness at end diastole(IVSTd),left ventricular posterior wall thickness at end diastolic(LVPWTd)were evaluated by M-mode ultrasound.Left ventricular ejection fraction(LVEF) were calculated by Teich method.Echocardiographic evaluations included LA diameter(LAD1),LA major dimension(LAD2),LA minor dimension(LAD3),RA major dimension(RAD1),RA minor dimension(RAD2).LA maximal area(LAAmax),LA maximal volume(LAVmax),LA minimal volume(LAVmin),systolic LA filling rate(dv/dtS),early diastolic LA emptying rate(dv/dtE) and late diastolic emptying rate(dv/dtA) were derived using LAVT.Then calculated the LA emptying fraction(LAEF).Results Compared with control group,the LAD1,LAD2,LAD3,RAD1,RAD2,LAAmax,LAVmax,LAVmin and dv/dtE were significantly increased and the LAEF,dv/dtS,dv/dtA significantly decreased in lone atrial fibrillation group.There were no significant differences in LVEDD,LVESD,IVSTd,LVPWTd,LVEF between lone atrial fibrillation group and contral group(all P>0.05).Compared with control group,the LAD1,LAD2,LAD3,RAD1,RAD2,LAAmax,LAVmax,LAVmin and dv/dtE were significantly increased and the LAEF,dv/dtS,dv/dtA significantly decreased in hypertensive atrial fibrillation group.There were no significant differences in LVEDD,LVESD,IVSTd,LVPWTd,LVEF between hypertension atrial fibrillation group and control group(P>0.05).The LAAmax,LAVmax,LAVmin were significantly higher and the LAEF,dv/dtS,dv/dtE,dv/dtA significantly lower in hypertensive atrial fibrillation group compared with lone atrial fibrillation group(all P<0.05).There were no significant differences in LAD1,LVEDD,LVESD,IVSTd,LVPWTd,LVEF,LAD2,LAD3,RAD1,RAD2,between hypertensive atrial fibrillation group and lone atrial fibrillation group(all P>0.05).Conclusions Left atrial function of atrial fibrillation patients is impaired.Compared with LAF patients,LA function is significantly impaired in patients with HAF.LAVT can evaluate left artial size and function in patients with atrial fibrillation accurately and rapidly.