超声心动图对阵发性房颤患者左房顿抑及其影响因素的研究

目的探讨阵发性房颤患者复律后左房顿抑情况及其可能影响的因素。方法阵发性房颤组35例,持续性房颤组19例,对照组为同期体检健康者30例。超声心动图检测房颤患者复律当日、3 d、7 d、1个月的左房整体、局部收缩功能,并与对照组比较。房颤患者于复律当日检测血浆心钠素。结果阵发性房颤组复律当日和3 d时二尖瓣口血流频谱A峰最大流速(VA)、左房射血力(LAF)、肺静脉口血流频谱负向a波最大流速(PVa)、二尖瓣环舒张晚期负向a波速度峰值(MVa)及左房壁局部组织多普勒a波速度峰值(LAVa)均低于复律后7 d和1个月(P均0.05),复律当日、3 d、7 d上述指标阵发性房颤组均高于持续性房颤组(P均0.05)。多元回归分析显示阵发性房颤组房颤持续时间和血浆心钠素水平与复律当日LAF独立相关。结论阵发性房颤患者复律后存在左房顿抑,房颤持续时间和血浆心钠素水平是其独立危险因素。

Left atrial stunning and its influentiaI factors in patients with paroxysmal atrial fibrillation evaluated by echocardiography

Objective To evaluate the left atrial （LA） stunning and its possible influential factors in patients with paroxysmal atrial fibr/llation （AF） post cardioversion. Methods The patients were devided into two groups, including paroxysmal atrial fibrillation group （n=35） and persistant atrial fibrillation group （n=19）. Thirty healthy people were adopted as control group. The whole and local contractile function of left artrium was evaluated by echocardiography post cardioversion at 1st day, 3rd day, 7th day and one month. The plasma level of atrial natriuretic peptide（ANP） was tested at the first day post cardioversion. The results were compared with control group. Results The factors including A wave velocity of blood spectrum in mitral orifice（VA）, left atrial ejection force（LAF）, negative a wave velocity of blood spectrum in pulmonary vein entrance（PVa）, negative a wave peak velocity of end diastolic period of mitral annulus and a wave peak velocity of tissue doppler imaging（TDI） in left atrial wall in paroxysmal AF group measured at the 1st and 3rd day were lower than those at the 7th day and one month later after cardioversion（P〈0.05）. The factors above-mentioned in paroxysmal AF group tested at the 1st, 3rd and 7th day post cardioversion were higher than those in persistent AF group（P〈0.05）. Multiple regression analysis showed there was an independent relationship between duration time of AF, level of ANP and LAF measured at the first day post cardioversion in paroxysmal AF group. Conclusion Duration time of AF and level of ANP are two independent risk factors to predict LA stunning which existing in patients with paroxysmal AF post cardioversion.