二维斑点追踪技术对阵发房颤患者左心房功能的研究

目的：应用二维斑点追踪技术观察阵发房颤患者左心房功能的变化。方法：住院患者共63例,年龄39~83岁,平均（61.80±10.93）岁,男34例,女29例。阵发房颤组33例,对照组30例。所有患者均在窦性心律时行常规二维超声检查后应用Echo PAC软件脱机分析,测量左心房前后径、左心房面积、室间隔厚度、左心室前后径、左室射血分数;测量二尖瓣舒张末期A峰峰值速度及A峰积分。应用二维斑点追踪技术,获得左心房长轴方向整体应变曲线,测量左心房长轴整体峰值应变和达峰值应变时间、房缩期应变,计算两组间四腔观及二腔观达峰值应变时间差的绝对值。结果：应用二维斑点追踪技术比较两组间四腔切面及二腔切面达峰值应变时间差的绝对值,阵发房颤组较大（分别为52.83±32.29、31.33±20.27,P<0.05）,阵发房颤组心房收缩期应变值较对照组减低[分别为-（10.09±3.33）、-（13.74±3.14）,P<0.05]。结论：阵发房颤患者左心房心肌储存血液势能的能力不变,但心房壁间传导存在明显的不均一性,左心房整体的助力泵功能下降。二维斑点追踪技术能无创及定量评价左心房整体的功能异常。     

Right atrial spontaneous echo contrast and thrombi in atrial fibrillation: a transesophageal echocardiography study.

BACKGROUND: Previous studies have reported the clinical and echocardiographic findings of patients with left atrial spontaneous echo contrast (SEC) and thrombi. We sought to study these characteristics in patients with right atrial SEC and thrombi. METHODS: We reviewed 580 consecutive patients from the ACUTE (Assessment of Cardioversion Using Transesophageal Echocardiography) Registry and found 79 patients (14%, aged 67 +/-13 years, 67 male) with transesophageal echocardiography (TEE) findings of right atrial SEC or thrombi (group 1). This group was compared with a control group of 75 consecutive patients (group 2) (aged 68 +/- 13 years, P = not significant; 49 male, P <.005) from the registry with no TEE findings of SEC or thrombi in the left or right atrium. RESULTS: Atrial fibrillation was present in 60 of 79 group 1 patients (76%). Five right atrial (6%) and 11 left atrial (14%) thrombi were identified. Both left ventricular ejection fraction (39% +/- 16% versus 47% +/- 14%; P =.0005) and presence of right ventricular dysfunction (n = 44 versus 18; P =.0001) differed significantly between groups 1 and 2, respectively. Right atrial area (24 +/- 6 cm(2) versus 22 +/- 6 cm(2); P = .02) was larger in patients in group 1. Left atrial SEC was present in 68 of 79 group 1 patients (86%). Patients with right atrial thrombi and right atrial SEC had a longer duration of arrhythmia (524 +/-812 days versus 147 +/-368 days, P <.05) than patients with right atrial SEC only. CONCLUSIONS: Right atrial SEC has a prevalence of 14% in patients with atrial arrhythmia who undergo TEE-guided cardioversion. Right atrial thrombi are a rare finding and were seen in fewer than 1% (5/580) of patients with atrial arrhythmia. Right atrial thrombi among patients on anticoagulation therapy were not associated with clinically significant pulmonary embolism.     

经食管超声心动图对心房颤动患者右心耳自发显影回声和血栓发生的研究

目的探讨经食管超声心动图(TEE)观察慢性心房颤动(房颤)时右心房、右心耳自发显影(SEC)和血栓发生情况。方法选取26例房颤患者和13例窦性心律患者，常规经胸超声心动图资料留取后，采用TEE充分清楚显示左、右心耳图像并采集血流流速曲线和其他相应指标。结果26例房颤患者左心耳内均可测及SEC，共测及血栓形成者10例；房颤患者右心耳内有SEC者共17例，共测及右心耳血栓形成者1例。结论房颤时右心耳内可有血栓发生，TEE检查在房颤抗凝治疗中和复律前后具有重要意义。     

二维斑点追踪超声心动图对阵发性心房颤动患者左心室功能及机械离散度的评价

目的应用二维斑点追踪超声心动图（2D-STE）评价阵发性心房颤动（PAF）患者左心室功能及机械离散度（MD）。 方法回顾性选取2019年10月至2020年11月于首都医科大学附属北京朝阳医院心内科确诊的PAF患者37例,同时选取健康对照组29例。所有研究对象均行经胸超声心动图检查,常规测量二维超声心动图参数,并采集左心室心尖四腔心、两腔心及三腔心切面动态图像,应用2D-STE测量左心室各节段及整体纵向应变（GLS）,以各节段应变达峰时间标准差表示MD。评价各参数的组间差异,并进行可重复性分析。 结果PAF组左心房内径（LAD）、左心房容积指数（LAVI）、左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVSd）、室间隔厚度（IVST）及左心室后壁厚度（LVPWT）均较对照组增大（P均＜0.05）,左心室射血分数（LVEF）较对照组减低［（59.3±4.7）% vs（63.3±4.0）%,P＜0.05］。与对照组相比,PAF组左心室GLS绝对值减低［（-17.9±2.3）% vs（-20.7±1.7）%,P＜0.05］、MD增加［（59.3±19.6）ms vs（43.0±10.2）ms,P＜0.05］。与对照组相比,左心房未扩大的PAF患者已出现GLS降低、MD增大,差异均有统计学意义（P均＜0.05）。GLS和MD观察者内和观察者间ICC均＞0.80。 结论PAF患者存在左心室收缩功能早期受损,2D-STE可为其评估提供有价值的信息,从而为PAF患者的早期干预和临床决策提供可靠依据。     

Left atrial strain by three-dimensional speckle tracking echocardiography

The International Journal of Cardiovascular Imaging -     

斑点追踪及声学造影对阵发性房颤复发的预测作用

目的 探讨斑点追踪技术及右心声学造影对阵发性房颤复发的预测作用。方法 对2019年1月至2019年12月经我院心内科诊断为阵发性房颤（PAF）患者33例进行前瞻性研究,分别在房颤发作时及未发作时行超声心动图及右心声学造影增强检查,测量造影前后右室舒张末面积、右室收缩末面积,计算右室面积变化分数（FAC）;观察右室心内膜边界变化。脱机分析房颤发作及未发作时三尖瓣瓣环平面收缩期位移（TAPSE）、左室整体纵向应变（LVGLS）及右室整体纵向应变（RVGLS）;以造影后及房颤未发作时的数据作为基线值;6个月后根据房颤是否复发分为两组,再次测量上述参数,比较各组数据之间差异。结果 图像改善值≥6者造影前后FAC差异有统计学意义。房颤未发作时LVGLS、RVGLS较发作时下降（P<0.05）。6个月后房颤复发组RVGLS较本组基线值下降（P<0.05）,且低于未复发组（P<0.05）。复发组RVGLS基线值低于未复发组（P<0.05）,各组之间LVGLS差异无统计学意义。RVGLS <17.98时,预测PAF复发敏感性71.1%,特异性72.9%。结论 RVGLS可敏感反映右室功能变化,对PAF复发具有一定的预测价值;LVGLS对PAF复发无预测价值。右心声学造影增强检查可明显改善右室图像清晰度,对预测PAF的复发无明显作用。     

心房颤动患者左心耳功能的三维超声及斑点追踪成像研究

目的 应用斑点追踪成像技术及经食管实时三维超声成像评价心房颤动(房颤)患者左心耳舒缩运动及功能变化特点.方法 22例阵发性房颤组患者、21例持续性房颤患者.将左心耳分为基底段(B)、中段(M)、顶部(A)三个部分.应用三维容积法测量左心耳整体排空分数(LAA-EF)、基底段排空分数(B-EF)、中段排空分数(M-EF)和顶部排空分数(A-EF).应用斑点追踪成像技术测量左心耳基底段、中段、顶部各节段收缩期应变率(SRS)和舒张期应变率(SRD).结果 阵发性房颤组和持续性房颤组LAA-EF、B-EF、M-EF、A-EF均低于对照组,持续性房颤组低于阵发性房颤组.与对照组比较,阵发性房颤组和持续性房颤组的左心耳基底段、中间段、顶部各段的SRS和SRD均降低,以持续性房颤组降低更显著.结论 阵发性房颤和持续性房颤均可导致左心耳整体和局部舒缩功能降低,以持续性房颤为甚.

Abstract：

Objective To evaluate left atrial appendage regional function and movement changes of systolic and diastolic in patients with atrial fibrillation by speckle tracking imaging(STI) and real-time three-dimensional transesophageal echocardiography(RT-3D TEE).Methods Sixty-seven patients underwent RT-3D TEE was divided into 24 controls,22 paroxysmal atrial fibrillation,21 persistent atrial fibrillation.Left atrial appendage was divided into basal,middle and apical segment.Left atrial appendage emptying fraction of the overall (LAA-EF),basal emptying fraction (B-EF),middle emptying fraction (M-EF) and apical emptying fraction (A-EF) was measured by three-dimensional volume measurement.Each segment systolic strain rate (SRS) and diastolic strain rate (SRD) was measured by STI.Results LAA-EF,B-EF,M-EF,A-EF of paroxysmal atrial fibrillation and persistent atrial fibrillation group were lower than those of the control group,and persistent atrial fibrillation group was the lowest in the three groups.Compared with the control group,SRS and SRD of left atrial appendage basal,middle,apical segment was lower in paroxysmal atrial fibrillation group and persistent atrial fibrillation group,and persistent atrial fibrillation group decreased more significantly.Conclusions Paroxysmal atrial fibrillation and persistent atrial fibrillation can lead to left atrial appendage global or local systolic and diastolic function to reduce,and persistent atrial fibrillation decreased more significantly.     

超声心动图及二维斑点追踪评估心房颤动对左心房形态及功能的影响

目的:应用超声心动图及二维斑点追踪技术评估非瓣膜病性房颤的左心房形态及功能变化,并探讨超声心动图参数对隐匿的阵发性房颤的辅助诊断价值。方法:顺序入组2020年7月24日至2020年8月5日复旦大学附属中山医院收治的非瓣膜病性房颤患者62例,根据行超声心动图检查时为窦性心律或房颤心律分为房颤窦律组(n=32)和房颤组(n=30),另选30例健康对照,在机测量左心房最大容积(left atrial maximum volume, LAVmax)、最小容积(left atrial minimum volume, LAVmin)、左心房排空分数(left atrial emptying fraction, LAEF)、左心房容积指数(left atrial volume index, LAVI),使用Qlab软件脱机测量左心房存储应变(left atrial reservoir strain, LASr)、通道应变(left atrial conduct strain, LAScd)、收缩应变(left atrial contraction strain, LASct)。结果:LAVmax、LAVmin、LAVI在对照组、房颤窦律组、房颤组逐渐增大,LASr则逐渐减小(均P0.05);房颤窦律组和房颤组LAScd较对照组显著降低(P0.05),但房颤窦律组与房颤组间差异无统计学意义。LAVmin:截断值22.3 mL,灵敏度0.625,特异度0.889,AUC 0.793;LAScd:截断值-19.93%,灵敏度0.813,特异度0.852,AUC 0.826,LAVmin和LAScd对于阵发性房颤具有较好的诊断价值。LAEF:截断值62.95%,灵敏度0.741,特异度0.875,AUC 0.840;LASr:截断值32.73%,灵敏度0.889,特异度0.750,AUC 0.880,LAEF和LASr对于阵发性房颤具有较好的排除价值。结论:房颤窦律组、房颤组的左心房容积较对照组逐渐增大,LAEF及LASr则逐渐降低。超声评估的左心房形态及功能参数,尤其是LAVmin、LAScd、LAEF和LASr有助于窦性心律受检者阵发性房颤的诊断与排除。     

二维斑点追踪超声心动图评价心力衰竭患者左心房功能

目的 应用二维斑点追踪超声心动图(STE)评价心力衰竭患者左心房功能变化.方法 收集射血分数正常的心力衰竭(HFNEF)和射血分数减低的心力衰竭(HFREF)患者各30例,以正常志愿者30名作为对照组.采用实时三维超声心动图(RT-3DE)测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房收缩前容积(LAVpre),计算左心房整体射血分数(LAEF)、左心房被动射血分数(LAPEF)、左心房主动射血分数(LAAEF);应用STI技术获取左心房各壁各节段应变及应变率曲线,分别测量左心室收缩期、舒张早期、舒张晚期左心房峰值应变和应变率,并计算其平均值.结果 与对照组相比,HFREF组和HFNEF组的LAVmax、LAVmin、LAVpre增大(P均＜0.05);对照组、HFREF组和HFNEF组3组间LAEF、LAPEF、LAAEF测值呈递减趋势(均P＜0.05).3组间储备期、通道期的应变及应变率和辅泵期的应变率呈递减趋势.LAEF与储备期中间段应变率相关性较好(r=0.76,P＜0.01);LAPEF与通道期中间段应变率相关性较好(r=-0.61,P＜0.01);LAAEF与辅泵期中间段应变率相关性较好(r=-0.61,P＜0.01).结论 STE可准确、敏感地反映心力衰竭患者左心房功能.     

二维斑点追踪技术评价肥厚型心肌病左心房功能

目的：探讨肥厚型心肌病（HCM）患者左心房功能的临床意义。方法：HCM患者和健康者各30例,利用斑点追踪超声心动图（STE）测量左室整体纵向应变峰值（LV-GLPS）、左房整体纵向应变峰值（LA-GLPS）、左室收缩期左房应变率（LASRs）、舒张早期应变率（LASRe）及左房收缩期应变率（LASRa）,比较两组参数的差异,并分析LA-GLPS和LV-GLPS相关性。结果：与正常组比较,HCM组LA-GLPS、LASRs、LASRe、LASRa及LV-GLPS均明显减低（P<0.01）,LA-GLPS与LV-GLPS呈显著负相关（r=-0.77,P<0.01）。结论：HCM患者左房容器、通道及助力泵作用三大功能均减低,左房功能损害程度与左室功能紊乱程度密切相关。     

Assessment of left atrial function using speckle tracking echocardiography in ankylosing spondylitis: a case-control study

The aim of this study is to assess the left atrium (LA) deformation parameters by using 2D speckle tracking echocardiography (2D-STE) in ankylosing spondylitis (AS) patients and to evaluate the relationship between these parameters and AS clinical indexes. 30 patients with AS (22 males, 8 females) and 30 healthy individuals (19 males, 11 females) were enrolled in this study. Transthoracic echocardiography was performed to both groups. Besides the conventional echocardiographic parameters, the LA strain parameters; including systolic-reservoir (LA S-S), early diastolic-conduit (LA S-E), late diastolic-contraction (LA S-A) were measured. No significant difference was found between two groups in terms of conventional echocardiographic parameters except mean deceleration time (DT). Mean DT was prolonged in the AS patients compare with the control group (173.5?±?22.5 vs. 155.3?±?36.7, p?=?0.025). In the AS patients, LA S-S (48.3?±?9.4 vs. 56.9?±?10.1, p?=?0.001), LA S-E (26.4?±?6.4 vs. 31.6?±?7.3, p?=?0.005) and LA S-A (21.9?±?4.7 vs. 25.4?±?5.7, p?=?0.013) values were statistically lower than the control group. Also a negative correlation was observed between the Bath Ankylosing Spondylitis Metrology Index (BASMI) and LA S-S (r?=???0.509, p?=?0.004), LA S-E (r?=???0.501, p?=?0.005). Our study demonstrated that 2D-STE is a useful method to determine the left atrial involvement in AS patients without the clinical evident of cardiovascular disease.     

The impact of high-normal blood pressure on left ventricular mechanics: a three-dimensional and speckle tracking echocardiography study

To assess the presence of subclinical left ventricular myocardial dysfunction in subjects with high-normal blood pressure (BP) and untreated arterial hypertension, using three-dimensional (3D) echocardiography strain analysis. This cross-sectional study included 49 subjects with optimal BP, 50 subjects with high-normal BP, and 50 newly diagnosed untreated hypertensive patients matched by gender and age. All the subjects underwent 24 h blood pressure monitoring and complete two-dimensional and 3D echocardiography examination. The enrolled subjects were grouped according to 24 h systolic BP values, dividing the subjects with optimal BP from those with high-normal BP and the hypertensive patients (cut-off values were 120 and 130 mmHg, respectively). 3D global longitudinal strain was significantly lower in the high-normal BP group and the hypertensive patients, in comparison with the optimal BP group (?20.5 ± 3.3 vs. ?18.7 ± 2.8 vs. ?17.6 ± 2.7 %, p < 0.001). Similar results were obtained for 3D global circumferential strain (?18.6 ± 3 vs. ?17.1 ± 2.9 vs. ?16 ± 2.5 %, p < 0.001), as well for 3D global radial strain (49.4 ± 9.5 vs. 44.7 ± 8.1 vs. 43.5 ± 7.8 %, p = 0.002), and global area strain (?31.2 ± 4.8 vs. ?28.7 ± 4.2 vs. ?27.1 ± 4.5 %, p < 0.001). LV twist was increased in the hypertensive patients in comparison with the high-normal and the optimal BP groups (10.1° ± 2.4° vs. 10.8° ± 2.6° vs. 13.8° ± 3.1°, p < 0.01), whereas untwisting rate significantly and gradually decreased from the optimal BP group, across the high-normal BP group, to the hypertensive patients (?135 ± 35 vs. ?118 ± 31 vs. ?102 ± 27°/s, p < 0.001). 3D echocardiography revealed that the subjects with high-normal BP suffered subclinical impairment of LV mechanics similar as the hypertensive patients.     

二维斑点追踪技术评价心脏再同步化治疗对左心房功能的影响

目的 采用超声二维斑点追踪技术(STE)评价心脏再同步化治疗(CRT)后患者的左心房功能,探讨其临床应用价值。 方法 接受CRT的心力衰竭患者49例,在术前3天及术后3个月应用Simpson法计算左心房被动射血分数(LAPEF)和主动射血分数(LAAEF),采用STE检测左心房侧壁及房间隔收缩期应变率(SRs-LA、SRs-IAS)、舒张早期应变率(SRe-LA、SRe-IAS)、舒张晚期应变率(SRa-LA、SRa-IAS),同时测量左心室收缩末容积(LVESV)和射血分数(LVEF)。将术后LVESV减小率(ΔLVESV)≥15%定义为CRT短期治疗有效。 结果 CRT术后3个月的27例患者(55.10%)CRT短期治疗有效(R组)。术前R组患者的所有参数与无效患者比较差异无统计学意义,术后参数与无效患者比较,R组患者的LVESV减小,LVEF增大,LAPEF、LAAEF增加,SRs-LA、SRe-LA、SRa-LA、SRs-IAS、SRe-IAS、SRa-IAS明显增加(P均＜0.05)。 结论 CRT短期可明显改善左心房功能;STE能准确评价左心房功能。     

二维斑点追踪显像技术联合实时三维超声心动图评价尿毒症患者左心房功能的定量研究

目的 应用二维斑点追踪显像技术(2D-STI)和实时三维超声心动图(RT-3DE)分别从心肌应变和容积变化的角度对尿毒症患者左心房功能进行定量评估,旨在探讨该群患者不同左房容积状态下左心房功能状况,为临床早期诊疗提供依据。方法 研究对象为69例尿毒症患者(尿毒症组)和22例正常人(对照组),RT-3DE时间-容积曲线获取左心房容积指标：最大容积(LAV_max)、最小容积(LAV_min)、收缩前容积(LAVp),计算左心房总射血分数(LAEF)、被动射血分数(LAPEF)、主动射血分数(LAAEF),容积指标LAVI由体表面积标化LAV_max得到。其中尿毒症组根据LAVI大小分为LAVI增高组(ELA组,LAVI＞34ml/m₂)和 LAVI正常组(NLA组,LAVI≤34ml/m₂ )。再应用2D-STI对上述受检者进行心肌应变及应变率曲线分析,获取参数包括：左心房壁平均应变(Sg、Se和Sa)及应变率(SRs、SRe和SRa)。结果①左心房壁平均Sg、SRs在对照组、NLA组、ELA组三组之间依次减低;与对照组相比较,NLA组、ELA组左心房壁平均Se、SRe均显著减低(P均＜0.05);NLA组Sa高于对照组,ELA组低于对照组(P均＜0.05)②NLA组LAEF、LAAEF高于对照组,ELA组低于对照组(P均＜0.05);LAPEF在对照组、NLA组、ELA组三组之间依次减低(P均＜0.05);③LAPEF与SRe具有较强的相关性(r=0.529,P=0.000);LAEF与Sa、SRa呈较好的正相关(r分别为0.501、0.498,P均=0.000)。结论 尿毒症患者左心房功能改变早于左心房构型改变,应用2D-STI联合RT-3DE技术可简便、快捷、准确评价其左心房功能,为临床早期诊疗提供依据。     

Left atrial thrombi in non-rheumatic atrial fibrillation: assessment of prevalence by transesophageal echocardiography

To determine the prevalence of left atrial thrombus in hospitalized patients with non-rheumatic atrial fibrillation, 48 patients were consecutively studied with single-plane transesophageal echocardiography. There were 23 males (48%) and 25 females (52%). The mean age was 66±11 years (range 43–87). Thrombus was detected in 13 patients (27%) 11 were confined to the left atrial appendage, 1 to the atrial body and appendage, and 1 to the left upper pulmonary vein. Prevalence of atrial thrombus was not different among those patients with or without previous stroke [4/16 (25%) vs 9/32 (28%), p=NS] or between patients > 65 years and patients ≤ 65 years old (p=NS). Atrial thrombus was detected more frequently in patients with reduced left ventricular global systolic function than in those with normal function [7/14 (50%) vs 6/34 (17%), p<0.05]. In patients with spontaneous contrast echoes in the left atrium, thrombi were visualized more often than in those without spontaneous echoes [10/24 (41%) vs 3/24 (12%), p<0.05]. The finding of the atrial spontaneous contrast echoes was more frequent among patients with reduced left ventricular global systolic function [11/14 (78%) vs 13/34 (37%), p<0.02]. We conclude that in hospitalized patients with non-rheumatic atrial fibrillation the prevalence of left atrial thrombus is high. Reduced left ventricular global systolic function identifies a subset of patients at high risk for formation of thrombus in the left atrium.     

实时三维、多平面二维经食管超声心动图在房间隔缺损测量的对比研究

目的比较实时三维、多平面二维经食管超声心动图在房间隔缺损（atrial septal defect, ASD）测量的应用价值。方法对67例继发孔型房间隔缺损患者分别应用经食管二维超声常规切面法、经食管二维超声十二切面法、实时三维经食管超声法进行测量,并将各测量结果与封堵器大小行相关性分析。结果经食管二维超声常规切面法在整体（P < 0.001）、大ASD组（P < 0.001）、椭圆形ASD组（P < 0.01）测量ASD最大径小于实时三维经食管超声法,差异有统计学意义;经食管二维超声十二切面法在小ASD组（P < 0.05）测量ASD最大径大于实时三维经食管超声法,差异有统计学意义;实时三维经食管超声法测量房间隔缺损最大径与封堵器大小的相关性高于经食管二维超声常规切面法及十二切面法。结论实时三维经食管超声可准确测量房间隔缺损,对封堵器选择有重要指导作用。经食管二维超声十二切面法可与实时三维经食管超声法互为补充。     

经食管超声心动图对心房颤动时右心耳血流动力学的研究

目的　应用经食管超声心动图(TEE)技术观察慢性心房颤动(房颤)时右心耳结构、功能和血流流速曲线的改变。方法　选取 26例房颤患者和 13例窦性心律患者,采用TEE充分清楚显示右心耳图像并采集血流流速曲线和其他相应指标。结果　与对照组相比,房颤组右心房射血分数 (RAEF)和右心耳射血分数(RAAEF)均显著降低(P<0. 05~0. 01);房颤时右心耳血流流速曲线峰值排空、充盈流速和流速积分均显著下降(P<0. 05~0. 01)。右心耳峰值排空、充盈流速与右室射血分数 (RVEF)、RAAEF、RAEF、右心房最大面积(Smax RA)等指标具有显著的相关性。结论　TEE可以安全、准确地评价右心耳血流动力学情况;房颤时右心耳血流流速曲线是反映右心房、右心耳功能的良好指标。