双多普勒同步取样技术评价阵发性心房颤动患者发作期的左心室舒张功能

目的 采用双多普勒同步取样技术（双PW技术）测量阵发性心房颤动（房颤）患者发作期与间歇期舒张早期二尖瓣口血流峰值速度/瓣环峰值速度（E/e''），探讨双PW技术评价房颤患者不同病程中左心室舒张功能的可行性及可重复性。方法 连续选择阵发性房颤患者51例，其中间歇期28例（房颤间歇组），发作期23例（房颤发作组）。采用双PW技术同步获取同一心动周期舒张早期二尖瓣口血流峰值速度（E）、瓣环室间隔（S）及侧壁（L）位点峰值速度e''（S）、e''（L），计算其比值为E/e''（S）1、E/e''（L）1及E/e''（S）1、E/e''（L）1的平均值为E/e''（M）1。采用传统方法分别测得以上参数，计算其比值为E/e''（S）2、E/e''（L）2及E/e''（S）2、E/e''（L）2的平均值为E/e''（M）2。结果 与房颤间歇组比较，房颤发作组E/e''（S）1、E/e''（M）1增高（P<0.01）。双PW技术测量房颤患者的E/e''与传统方法测量E/e''相关系数为0.88（P<0.01）；对于同一观察者及不同观察者，双PW技术测量E/e''的Cronbach系数较传统方法更高，95%可信区间范围更小。结论 双PW技术评价房颤患者左心室舒张功能可行，其测量E/e''的可重复性较传统方法更好，有望为临床提供一种准确评价房颤患者舒张功能的新方法。

Dual gate Doppler in evaluation of left ventricular diastolic function of paroxysmal atrial fibrillation episodes patients

Objective To obtain E/e'' with dual gate Doppler in paroxysmal atrial fibrillation (PAF) episodes and intermittent respectively, and discuss the feasibility and repeatability of dual gate Doppler in assessing left ventricular diastolic function.Methods A total of 51 PAF patients with preserved systolic functions underwent echocardiography, including 23 cases in PAF episodes group and 28 cases in PAF intermittent group. With dual gate Doppler, the ratio E/e''(S)1 of transmitral flow peak velocity (E) and mitral annular septal peak velocity (e''S]) in early diastolic was measured simultaneously in the same cardiac cycle; the ratio E/e''(L)1 of transmitral E and mitral annular lateral peak velocity (e''L]) in early diastolic was measured simultaneously in the same cardiac cycle. The mean of E/e''(S)1 and E/e''(L)1 was E/e''(M)1.With traditional method, E/e''(S)2 and E/e''(L)2 were calculated in the way which E was measured by pulse wave Doppler while e''(S) and e''(L) were measured by tissue Doppler in different cardiac cycles. The mean of E/e''(S)2 and E/e''(L)2 was E/e''(M)2.Results Compared with PAF intermittent group, E/e''(S)1 and E/e''(M)1 increased significantly in PAF episodes group (P<0.01). E/e'' in dual gate Doppler was correlated to E/e'' in traditional method (r=0.88, P<0.01). For interobservers and intraobservers, the Cronbach coefficient with dual gate Doppler was higher and 95% confidence interval range was smaller.Conclusion Dual gate Doppler in evaluation of left ventricular diastolic function in atrial fibrillation is feasible. It can provide more repeatable measurements of E/e'' and can be a new prospective method to assess diastolic function in AF patients.