经食道超声对射频消融术前房颤患者左房及左心耳血栓的诊断价值分析

目的:探讨射频消融术前经食管超声对房颤患者左房及左心耳血栓的诊断价值。方法:选取在2016年7月至2019年3月期间来我院就诊并治疗的射频消融术前房颤患者80例作为本次研究的观察对象,按照检查方式的不同均分为两组,对80例接受射频消融术治疗的房颤患者分别行经胸超声检查(TTE)(对照组)和经食道超声检查(TEE)(观察组)。比较两组患者的左房血栓、左心耳血栓、左房自发声学显影(SEC)和左心耳自发声学显影的检出率。结果:对照组患者中:左房血栓检出4例(10.0%),左心耳血栓检出6例(15.0%),左房自发声学显影检出6例(15.0%),左心耳自发声学显影检出4例(10.0%),总检出率为50.00%(20/40);观察组患者中,左心房血栓检出8例(20.0%),左心耳血栓检出9例(22.5%),左房自发声学显影检出9例(22.5%),左心耳自发声学显影检出7例(17.5%),总检出率为82.5%(33/40);两组患者差异明显(P<0.05),在统计学方面有意义。结论:经食道超声检查射频消融前房颤患者左心房和左心耳血栓检出率高,对消融治疗有一定的临床价值。     

房颤介入治疗前经食管超声心动图对左房及左房耳血栓检出的临床意义

目的:探讨房颤(atrialfibrillation,Af)射频消融术前经食管超声(transesophageal echocardiography,TEE)对左房及左房耳内血栓检出的临床意义。材料与方法:对23例拟行射频消融术的患者同时进行经胸超声心动图(transthoracic echocardiography,TTE)和经食管超声心动图检查,分析左房和左心耳血栓检出情况。结果:23例房颤患者经胸超声心动图未检出左房及左房耳血栓,TEE在23例患者中发现3例左心耳血栓,占13%,左房耳自发显影(spontaneous echo contras,SEC)2例(8.7%)。结论:TEE在房颤介入治疗前检出左心耳血栓具有重要的临床意义。     

经食管及经胸超声心动图对风湿性心脏病左房血栓诊断的对比研究

目的研究多平面经食管超声心动图(TEE)及经胸超声心动图(TTE)对风湿性心脏病左房及左心耳血栓诊断价值比较。方法对临床欲行二尖瓣球囊扩张术及房颤复律的256例风心病患者TTE检查后行TEE检查,对左房血栓(LAT)、左心耳血栓(LAAT)的检出情况进行总结分析。结果TTE:检出血栓者17例,检出率6.64%,血栓位于左房腔内12例,单纯位于左心耳部2例,左房与左心耳部并存3例,有自发云雾状回声者2例。TEE:新增检出血栓者32例,检出率12.5%,血栓位于左房腔内3例,单纯位于左心耳部28例,左房与左心耳部并存1例,有自发云雾状回声者13例。结论TEE对左心耳部血栓的检出率显著高于TTE,特别是新鲜血栓及左房云雾状回声优于TTE。     

非瓣膜病房颤并左房血栓患者的TEE研究

本文研究经食管超声心动图检查的两组慢性非瓣膜病房颤患者，Ａ组为检出左房或左心耳血栓者，２４例；Ｂ组为无左房或左心耳血栓者，２４例。发现与Ｂ组患者相比，Ａ组的左房自发超声显影现象明显增高，而左房有左心耳内血流速度明显减低。说明房颤而左房内血汉速度明显减低者，局部血流淤滞明显，是房内血栓形成的预示因子。     

二尖瓣环位移对孤立性心房颤动患者左心耳血栓的预测价值

目的探讨二尖瓣环位移对孤立性心房颤动患者左心耳血栓的预测价值。方法选取116例孤立性心房颤动且经常规经胸超声测量左室收缩功能(LVEF)≥50%的患者作为病例组,另选取50例健康体检者作为对照组。病例组据左心耳内血栓情况进一步分为无血栓组(NTH组)、自发显影组(SEC组)和血栓组(TH组)。利用二维斑点追踪技术测量二尖瓣环位移(TMAD)值,详细记录患者的基线资料及常规经胸超声参数,比较各组的TMAD值,分析左心耳血栓与TMAD值间的关系。结果各病例组分别与对照组比较心率有统计学差异,病例组内TH组与其他两组比较心率有明显差异(均P0.05)。与对照组相比,各病例组的左房内径(LAd)均大于对照组,TMAD值均小于对照组(均P0.05)。病例组内,SEC组和TH组的LAd、左房舒张末期容积(LAEDV)和左房收缩末期容积(LAESV)均大于NTH组,各TMAD值均小于NTH组(均P0.05)。结论孤立性心房颤动患者二尖瓣环位移值与左心耳血栓有明显相关性。     

阵发性房颤环肺静脉电隔离术前后左房结构和功能的研究

目的经胸超声心动图(TTE)和经食道超声心动图(TEE)联合应用对阵发性房颤患者肺静脉前庭电隔离术前后左房、左心耳结构和功能的评价。方法46例阵发性房颤患者和16例正常对照组接受TTE和TEE检查,测量左房内径指数(LADI)、左房面积指数(LAAI)、左房容积指数(LAVI)、左房射血力(LA-EF)、左心耳内径指数(LAADI)、左心耳最大面积指数(LAAmaxI)、左心耳最小面积指数(LAAminI)、左心耳射血分数(LAA-EF)、左心耳最大排空血流速度(LAA-P)和左心耳最大充盈血流速度(LAA-F)及有无血栓征象。41例确诊无左心房及左心耳血栓的患者行肺静脉前庭电隔离术。术后6个月以上对其中39例患者随访行TTE和TEE复查。结果肺静脉前庭电隔离术组、术后随访组与正常对照组间左房结构、功能均有显著差异(P<0.05～P<0.01)。三组间左心耳的结构和功能亦均有显著差异(P<0.05～P<0.01)。阵发性房颤患者左房、左心耳结构与其功能的变化呈线性负相关。结论TTE和TEE联合应用为评价阵发性房颤患者左房的结构、功能以及肺静脉前庭电隔离术前病例的筛选、术后疗效的评估提供重要信息。     

经食管超声心动图诊断左房血栓的探讨

风心病MS病人左房内有无血栓对临床进行除颤、经皮二尖瓣球囊扩张术、交界分离术及瓣膜置换术等治疗方法的选择上有十分重要的意义。常规TTE在对左房血栓的诊断因其敏感性及特异性低而受到限制。TEE为探测左房内血栓提供了新的途径。本文研究表明:(1)TEE对左房血栓的诊断,特别是对左心耳的诊断明显优于TTE。(2)有血栓组左房前后径大于无血栓组。(3)有血栓组的房颤发生率及左     

房颤患者左心耳血栓形成与结构功能的关系

目的 分析房颤患者血栓形成与左心耳结构功能的关系。方法 采用经食管超声心动图检测88例房颤患者及18例对照组患者的左心腔前后径(LA-D)、左心耳入口宽度(LAA-W)、左心耳长度(LAA-L)、左心耳前壁、后壁及顶部的运动速度及左心耳充盈及排空速度等指标。根据左心耳内透声,将房颤患者分为无自发显影(NO SEC)亚组、自发显影(SEC)亚组、泥浆样改变(sludge)亚组和血栓(thrombosis)亚组,并将各指标与对照组进行比较。结果 与对照组相比,房颤组患者左心耳结构及功能均有不同程度的改变;sludeg亚组及thrombosis亚组的LAA-W均较对照组增大,差异有统计学意义(P均<0.05);血栓亚组的LAA-L较对照组增大,差异有统计学意义(P<0.01);房颤各亚组的LA-D均较对照组扩大(P均<0.05);房颤各亚组的左心耳充盈及排空速度均较对照组降低(P均<0.05),在血栓亚组降低更为明显;除无自发显影亚组外,余各亚组的左心耳各壁运动速度差异均有统计学意义(P均<0.01)。结论 房颤患者左心耳内血栓形成与左心耳的结构以及功能改变密切相关。     

经食管超声心动图在风心病二尖瓣狭窄手术方式选择中的应用

目的：评价经食管超声心动图(TEE)在风心病二尖瓣狭窄手术方式选择中的应用价值。方法：67例风心病二尖瓣狭窄患者术前作经胸超声(TTE)和TEE检查，重点探查左房血栓、左心耳血栓、左房雾影、瓣膜返流和瓣膜病变等情况。结果：TTE检查拟行二尖瓣置换术21例，球囊成形术46例。46例球囊成形术者又经TEE检查后，新发现左心耳血栓12例，改二尖瓣置换术；10例二尖瓣轻度返流，TEE证实为中度返流，改二尖瓣置换术。结论：TEE在风心病二尖瓣狭窄手术方式选择中有决定性的作用，对左房血栓、左心耳血栓、左房雾影检出及二尖瓣返流的定量判断较准确、可靠。     

超声评价左心耳血栓形成的影响因素

目的应用超声心动图评价房颤患者左心耳血栓形成的相关因素及其预测价值。方法选取58例非瓣膜性房颤伴左心耳血栓患者为血栓组(A组),另选取60例非瓣膜性房颤不伴左心耳血栓患者为非血栓组(B组),记录患者基线资料。对两组患者进行经胸及经食管超声心动图检查,对比两组患者左房内径(LAd)、左房舒张末期容积(LAEDV)、左房收缩末期容积(LAESV)、左房射血分数(LAEF)、左室射血分数(LVEF)、左心耳口平均横径(LAA-w)及左心耳内血流速度(LAA-v),进行统计学分析。结果 A组LAEF、LVEF、LAA-v均小于B组,LAEDV、LAESV、LAd均大于B组(P0.05)。多因素Logistics回归分析显示LAd39.5 mm,LAEF48.5%与左心耳血栓形成相关,且校正了年龄、性别及CHA2DS2-VASc评分后亦如此。结论房颤患者左心耳血栓形成与左房结构及功能改变相关,且有一定预测价值。     

Transesophageal echocardiography assessment of left atrial appendage function in untreated systemic hypertensive patients in sinus rhythm.

To assess left atrial appendage (LAA) function in hypertensive patients without treatment, transesophageal echocardiography (TEE) was performed in 46 hypertensive patients in sinus rhythm, aged 40 to 55 years, and in 16 control subjects (group I) without cardiovascular disease, aged 41 to 54 years. The hypertensive patients were divided into 2 groups according to left ventricular (LV) systolic function: group II, the group with normal LV systolic function (ejection fraction 0.63 +/- 0.08), and group III, the group with LV systolic dysfunction (ejection fraction 0.39 +/- 0.05). The LAA late emptying velocities (EVs) were significantly reduced in the hypertensive subgroups compared with the control group (P <.001), but no significant difference in the LAAEV was found between groups II and III. The LAAEV in the hypertensive patients had a significant negative correlation with diastolic blood pressure, systolic blood pressure, and left atrial (LA) diameter. The maximal LAA areas were significantly larger in the hypertensive subgroups than in the control group (P <.05). No significant difference in LAA maximal area existed between groups II and III. The maximal LAA area in the hypertensive patients had a significant positive correlation with diastolic blood pressure, systolic blood pressure, and LA diameter, but a significant negative correlation with LV ejection fraction. With TEE, LA spontaneous echocardiographic contrast (SEC) was present in 6 (43%) of 14 patients in group III (P <.01) and in 7 (22%) of 32 patients in group II (P <.05). No significant difference in the occurrence of LASEC was found between groups II and III. Left atrial appendage thrombi by TEE were observed in 4 (29%) of 14 patients in group III (P <.05) and in 4 (13%) of 32 patients in group II (P = not significant). No significant difference in the occurrence of LAA thrombus existed between groups II and III. In conclusion, in patients with untreated hypertension, marked elevation of afterload imposed on the left atrium may involve both the left atrium and the LAA, resulting in impairment of LAA function. This condition may worsen with subsequent occurrence of SEC and later, thrombus formation. Therefore assessment of LAA function may be important even in the hypertensive patient in sinus rhythm.     

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.     

经食管超声心动图组织多普勒评价左心耳功能

目的观察窦性心律和心房纤颤（房颤）患者经食管超声心动图左心耳脉冲组织多普勒的图像特点,结合脉冲多普勒初步研究使用组织多普勒技术评价左心耳功能的价值。 方法窦性心律和房颤患者各15例均经食管超声心动图检查,房颤患者根据有无心房血栓或心房血流浓密自显影分为2组,并将经食管超声心动图的指标进行比较。 结果窦性心律患者的左心耳血流频谱和脉冲组织多普勒图像为可测量的三相波;房颤患者则表现为无规律的可测量的多相波。左心耳血流速度在各组间均有显著性差异;脉冲组织多普勒指标在窦性心律和房颤患者中有显著性差异,在有血栓和心房血流自显影的房颤患者中进一步降低或有进一步降低的趋势。 结论经食管超声心动图检查能获得可测量的左心耳（包括房颤患者）组织多普勒图像,可作为分析左心耳功能的重要补充。     

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。     

心房颤动患者左心房自发超声显影的超声学和方法学研究

目的 探讨心房颤动（房颤）患者左心房自发超声显影（SEC）的超声学机制。方法经胸或经食管超声心动图分别测定44例房颤患者左心功能、形态学参数、左心耳和左上肺静脉血流速度，背向散射积分定量测量左心房SEC，共线性分析筛选独立的血流速度参数，后者与显著性形态学指标行多因素分析。结果 与左心房SEC显著性相关的有左心房内径、左心耳入口内径、左心耳排空／充盈血流速度峰值、积分（Vi）和充盈血流速度平均值（RVm）、左上肺静脉血流速度S／D波峰值、S波积分（PVS-VTI）和D波平均值（PVD-M）（P〈0．05-0．01）。共线性分析显示，RVm、RVi、PVS-VTI和PVD-M为独立、代表性血流速度指标。多因素分析显示，RVm和PVD-M为左心房SEC的独立预测因子（P〈0．05）。结论 左心耳充盈顺应性降低和跨二尖瓣血流的阻挡为左心房SEC形成的主要超声学机制，共线性分析为研究血流动力学和左心房SEC之间相互关系的有效方法。     

Assessment of left atrial appendage filling pattern by using intravenous administration of microbubbles: comparison between mitral stenosis and mitral regurgitation.

Mitral stenosis (MS) and mitral regurgitation (MR) are the most frequent conditions that cause a dilation and dysfunction of the left atrial appendage (LAA). Despite similarly dilated LAA in patients with MS and MR, the incidence of LAA thrombi and the risk of thromboembolism is different between these patients. The purpose of this study was to characterize the filling pattern of LAA by using intravenous administration of perfluorocarbon-exposed dextrose albumin (PESDA) during transesophageal echocardiographic examination in patients with MS and MR. Twenty-four patients with moderate to severe MS, 12 patients with severe MR, and a control group including 30 patients with conditions other than mitral valve disease underwent transesophageal echocardiographic examination with an intravenous bolus injection of PESDA. LAA emptying and filling velocities and maximal and minimal areas of LAA and LAA ejection fraction were measured. Digital gray-scale intensity (GSI) of the left atrial (LA) and LAA cavity after PESDA injection was measured by off-line analysis. Compared with control patients, patients with MS or MR had larger maximal and minimal areas of LAA and reduced LAA ejection fraction. LAA peak emptying flow velocity was significantly lower in patients with MS compared with those of MR or control patients. LAA peak filling velocity was significantly lower in patients with MS compared with that of control patients. However, there was no significant difference of LAA peak filling velocity between the patients with MS and MR. There was no significant difference of GSI ratio of LAA and LA between patients with MR and control patients; however, GSI ratio of LAA and LA was significantly lower in patients with MS compared with that of MR. The incidence of LAA spontaneous echo contrast and LAA thrombi in patients with MS was significantly higher than that of the patients with MR and control subjects (P <.005). Despite similarly dilated LAA area and depressed contractile function of LAA in patients with MS and MR compared with control patients, profoundly impaired LAA filling with resultant flow stasis was demonstrated by contrast echocardiography in patients with MS. These findings may explain the higher incidence of LAA spontaneous echo contrast and thrombus in patients with MS.     

经食管超声心动描记术评价非风湿性房颤患者左心耳功能

目的应用多平面经食管超声心动图技术（ＴＥＥ）评价排风湿性房颤患者左心耳功能。方法对３０名健康人和３０例非风湿性房颤（ＮＲＡＦ）患者分别在心底短轴观测量了左心耳最大直径,同一心动周期内左心耳最大、最小面积及左心耳最大排空速度,并将ＮＲＡＦ患者按照左房自发显影及血栓的有无分为２组。结果ＮＲＡＦ组左心耳增大,收缩力及血流速度均减低,且这种变化在有血栓和（或）有血栓形成倾向的患者中更为明显。结论应用ＴＥＥ技术评价左心耳功能可为判断ＮＲＡＦ患者血栓栓塞危险程度提供新的依据。     

Novel computed tomography indexes of left atrial appendage stasis

Contrast enhanced multi-detector computed tomography (MDCT) may detect left atrial appendage (LAA) thrombus; however, its ability to qualify LAA stasis has not been studied. We sought to identify MDCT derived LAA radiographic parameters which could qualify LAA stasis as defined by established transesophageal echocardiography (TEE) parameters. Pre-procedural MDCT followed by TEE (median procedural time difference of 11 days) from 45 patients who underwent ablation for atrial fibrillation were analyzed retrospectively. Contrast enhanced, non-gated, helical MDCT (64 detector row) was performed according to the institutional protocol. Using a combination of parametric and nonparametric tests, the mean attenuation and heterogeneity parameters of LAA attenuation were correlated with the presence of spontaneous echocardiographic contrast and Doppler derived LAA emptying velocity on TEE. If significant correlation is observed, a receiver operating curve analysis will be performed. The baseline characteristics of the studied population were; age, 62 ± 11; CHADS2 score, 2.0 ± 1.2; heart rate, 79 ± 10 bpm; left ventricular ejection fraction, 49 ± 14 %. SEC was seen on TEE in 19 patients; ten with mild, eight with moderate, and one had severe SEC. No patients had LAA thrombus. Compared with the group without SEC, those with SEC had significantly increased coefficient of variation (0.19 vs. 0.14, p = 0.014) and range to mean ratio (1.04 vs. 0.73, p = 0.011). There was no significant correlation between mean LAA attenuation and LAA emptying velocity. However, the range, range to mean ratio, standard deviation and coefficient of variation of LAA attenuation had a significantly negative correlation with LAA emptying velocity (r = ?0.486, r = ?0.497, r = ?0.434, r = ?0.466, respectively, all p < 0.05). On receiver operating curve analysis, each of the heterogeneity parameters significantly discriminated LAA emptying velocities ≤30 cm/s, with areas under the curve of 0.88, 0.83, 0.81 and 0.76 respectively. In patients with atrial fibrillation, increased contrast heterogeneity within the LAA on MDCT correlated with decreased LAA emptying velocity on TEE. Contrast enhanced MDCT provides an adjunctive, noninvasive technique for Qualification of LAA stasis.     

应用实时三维经食管超声心动图评价非瓣膜性心房颤动患者左心耳形态和功能

目的 应用实时三维经食管超声心动图(RT3D-TEE)评价非瓣膜性心房颤动(AF)患者左心耳(LAA)形态及功能.方法 通过经胸超声心动图及RT3D-TEE采集图像,对29例心房颤动患者(AF组)和12例无器质性心脏疾病受试者(对照组)的LAA形态和功能进行比较.结果 AF组LAA口短径及左心耳舒张末期容积(LAA-EDV)测值显著高于对照组(P=0.01、0.02);AF组LAA的峰值血流排空速度,LAA口离心率和LAA射血分数均显著低于对照组(P=0.01、0.01、0.02).结论 与对照组相比,AF组LAA形态和功能有明显差异;应用RT3D-TEE对LAA进行形态和功能研究是可行的.