彩色多普勒超声心动图对房颤病人复律后左房收缩功能的观察

目的：对房颤病人电转复后左房收缩功能的观察。方法：应用彩色多普勒超声心动图对２０例房颤病人转复窦性心率者于复律后１小时，２４小时，２周，及４周分别测量二尖瓣口舒张期血流频谱的Ａ峰流速，判定房颤转复后心房收缩功能的恢复过程。结果：１５例病人二尖瓣血流频谱Ａ峰流速电转复后１小时０．３０±０．１０ｍ／ｓ增至第４周０．６２±０．１４ｍ／ｓ（Ｐ＜０．００１）；２例病人２４小时Ａ峰流速恢复正常且大于Ｅ峰流速；１例病人至转复后４周仍未出现Ａ峰。另２例病人转复后一周复颤，其中１例未出现Ａ峰，１例仅出现低小的Ａ峰，且不随时间变化。结论：房颤转复后左房机械功能出现“顿抑”，从而提供临床房颤转复后应给予适当的抗凝治疗。     

阵发性心房颤动对左心房大小及功能的影响

[目的]探讨阵发性心房颤动对左房大小及功能的影响.[方法]选取324例阵发性室上性心动过连、329例阵发性房颤及330例持续性房颤患者为研究对象,利用超声心动图检查测量各组的心房、心室腔大小,评价心脏功能,并对阵发性房颤复律前后心脏功能进行比较.[结果]持续性房颤组左房内径、左房客积、左房容积指数最大,阵发性房颤组次之,阵发性室上性心动过速组最小,而阵发性室上性心动过速组左房分数、左房排空容积最大、阵发性房颠组次之、持续性房颤组最小,三组差异有显著性(P<0.05);与复律前比较,阵发性房颤组复律后左房分数、左房排空容积均提高(P<0.05).[结论]阵发性房颤对左房大小及功能有明显影响,发作时间越长,对左房影响越严重,因此对阵发性房颤患者应积极复律,这对维护患者心功能,改善预后有重要的临床意义.     

三维斑点追踪技术评估非瓣膜性心房颤动患者左房低电压对左房结构及功能的影响

目的 应用三维斑点追踪技术评估非瓣膜性心房颤动（房颤）患者不同程度左房低电压对左房结构及功能的影响。方法 随机选取我院拟行射频消融术的房颤患者66例,术前记录患者临床资料,均行常规经胸超声心动图检查获得左房收缩末期前后径、左右径、上下径和左室舒张末期内径、左室射血分数（LVEF）、舒张早期二尖瓣血流峰值与二尖瓣环峰值运动速度比值（E/ e’）;三维斑点追踪技术获取左房储器期应变（LASr）、管道期应变（LAScd）、泵功能期应变（LASct）、左房射血分数（LAEF）。进行射频消融术时应用三维电解剖标测技术获得左房低电压区,根据低电压区面积与左房表面积的百分比定义左房低电压区程度,将患者分为无低电压患者组（Ⅰ组）、左房低电压区程度＜10%组（Ⅱ组）、左房低电压区程度≥10%组（Ⅲ组）,分别为29例、26例、11例。比较各组间上述参数的差异;分析左房应变参数与左房低电压区面积的相关性。结果 Ⅲ组CHA2DS2-VASc评分、陈旧性脑梗死或一过性脑缺血病史占比均较Ⅰ组、Ⅱ组增加,差异均有统计学意义（均P＜0.05＝。Ⅰ组与Ⅲ组、Ⅱ组与Ⅲ组E/e’＞14者占比比较,差异均有统计学意义（均P＜0.05＝;各组左房、左室大小参数、LVEF比较,差异均无统计学意义。Ⅲ组LASr、LAScd、LASct、LAEF均低于Ⅰ组和Ⅱ组,差异均有统计学意义（均P＜0.05＝;Ⅰ组与Ⅱ组各左房应变参数、LAEF比较,差异均无统计学意义。相关性分析显示,LASr、LAScd、LASct与左房低电压区面积均呈负相关（r=-0.538、-0.448、-0.501,均P＜0.05＝。结论 当左房低电压区程度达到10%时,左房结构虽未发生改变,但其功能已经减低,卒中患病率增加。三维斑点追踪技术可以早期发现非瓣膜性房颤患者左房低电压对左房功能的影响。     

超声评价肥厚型心肌病患者左房收缩功能的临床价值

目的探讨超声心动图评价肥厚型心肌病（HCM）患者左房收缩功能变化的临床意义。方法HCM患者和健康体检者各30例。常规测量左房内径、室间隔厚度、左室后壁厚度及二尖瓣E、A峰。Simpson’s法测量左房心动周期容积,计算左房主动排空分数（LAAEF）。分别采集各受试者的心尖二腔、四腔和心尖左室长轴观动态组织速度图像,获得应变率曲线测量左房收缩期峰值应变率（LASRa）,计算其平均值（mLASRa）。结果与对照组比较,HCM组I_AAEF和mLASRa增高,差异均有统计学意义（均P〈0．05）。HCM组mLASRa与IAAEF呈显著正相关（r=0．84;P〈0．01）。结论HCM患者左房辅泵功能增加,超声心动图能够通过评价HCM患者左房收缩功能为临床提供一定的信息。     

超声心动图评价冠心病合并房颤患者左房功能

目的：探讨应用超声心动图评价冠心病合并房颤患者左房功能的临床价值。方法：对冠心病合并房颤患者19例（心室律<120次/分）,窦性心律冠心病患者17例,及正常对照组20例健康人进行彩色多普勒超声检测。常规超声心动图测量参数包括左房大小（LAD）,双平面面积长度法测左房容量（LAVmax, LAVmin）;应用多普勒技术测量二尖瓣血流频谱参数：E峰、A峰及积分、E峰减速时间（DT）,计算E/A;肺静脉血流频谱收缩及舒张期速度和心房收缩期反流速度（S、D、Ar峰）及积分,计算S/D;左房射血分数（LAEF）;左房灌注分数（LAF）。结果：与对照组相比,冠心病合并房颤组左房收缩功能减低,冠心病组左房主动收缩增强（P<0.05）。冠心病伴房颤和不伴房颤患者左房舒张功能均减低,二组比较有明显差异（P<0.05）。结论：应用常规超声心动图能够评价冠心病合并房颤患者的左房功能。     

心房颤动直流电复律前后左心房功能变化的超声心动图研究

目的评价体外直流电复律对心房颤动(房颤)患者复律后左心房大小和容量的影响以及左心房大小与功能的关系。方法随机选择房颤患者68例,按心脏复律的方式分为直流电复律组36例,药物复律组32例,应用超声心动图测定其左房内径和容积,计算左房主动、被动排空容积及左房射血力。分析左房内径和容积变化与左房收缩功能的关系。结果房颤时所有患者的左房扩大,而恢复窦性心律后直流电复律组和药物复律组的左房上下径显著降低(P<0.05或P<0.001)。直流电复律与药物复律组比较,左房最大和最小容积显著增大(P<0.001或P<0.01)。左房机械功能正常患者与25例左房机械功能异常患者比较有较强的左房射血力;左心房机械功能降低的患者左心房内径和容积分别与左心房射血力呈负相关(r=-0.73和-0.78,P<0.001),而且左心房主动排空分数降低,管道容积却增加。结论体外直流电复律后许多患者出现左心房功能降低,心房收缩功能延迟恢复与持续的左房扩大有关;而药物复律患者的左房射血力较强与恢复窦性心律后左房容积明显降低有关。     

左房内径大小及房颤发作时间对房颤转复影响的观察

目的：探讨左房内径大小及房颤发作时间对房颤转复影响。方法：选取阵发性房颤患者166例,根据左房内径大小分为A组（左房内径〈40mm）、B组（左房内径≥40mm）;A组中根据房颤发作时间分为A1组（房颤发作〈48h）、A2组（房颤发作时间≥48h）,B组中根据房颤发作时间分为B1组（房颤发作〈48h）、B2组（房颤发作时间≥48h）,均给予口服胺碘酮药物转复房颤,观察房颤转复成功率。结果：A组房颤转复成功率明显高于B组（P〈0．01）,有统计学差异。A1组较A2组、B1组较B2组房颤转复成功率明显增高（P〈0．05）。结论：左房内径大小及房颤发作时间对房颤转复有明显影响。     

应变率成像对尿毒症患者左房收缩功能的研究

目的 探讨应变率成像评价尿毒症患者左房收缩功能的价值.方法 选取30例尿毒症患者为实验组,30例健康人为对照组,应用二维超声测量左房前后径(LAD);多普勒超声测量二尖瓣口舒张期血流E/A比值、A峰速度时间积分(A-VTI);组织多普勒测量二尖瓣环6点舒张期速度峰值(Aa);应变率成像测量房间隔、侧壁、下壁、前壁、后壁左房收缩期峰值应变率(SRa).结果 实验组与对照组之间LAD、E/A、A-VTI无显著性差异,Aa、SRa有显著性差异;实验组SRa与Aa相关性良好(P＜0.05,相关系数r＝0.83).结论 应变率成像能早期准确评价尿毒症患者左房收缩功能.     

左房舒张内径变化对鉴别二尖瓣血流正常与假正常的价值

目的应用超声心动图测量左房舒张期变化鉴别二尖瓣血流正常与假正常以评价左室舒张功能.方法对66例高血压病患者和59例健康人进行了研究.舒张功能包括测量二尖瓣血流E/A比值, E峰减速时间.66例舒张功能障碍的患者中46例为损伤类型(E/A＜1,E:左室舒张早期血流峰值速度,A:舒张晚期血流峰值速度),20例假正常类型(E/A＞1).用M-型超声心动图测量左房收缩和舒张期内径,左房排空分数(LAEF)计算方法为舒张末左房内径除以收缩末内径.结果左室功能损伤组LAEF 0.77±0.02,假正常组0.86±0. 05,对照组0.67±0.03,差异有高度显著性.结论舒张期左房内径的变化是用于检测左室舒张功能鉴别二尖瓣血流正常和假正常一个简单而实用的方法.     

超声心动图对房颤电转复后的心房机械功能的研究

目的　应用超声心动图观察房颤患者电除颤后心房收缩功能的变化。方法　2 0例房颤患者成功电除颤后,于复律后1 d、3 d、7d、1个月分别行超声心动图检查,测量二尖瓣血流频谱A峰流速( VA)、A峰速度时间积分( A- VTI)、心房充盈分数( AFF)和心房射血力( AEF) ,将结果进行统计学分析。结果　恢复窦律后第1 d,VA、A- VTI、AFF和AEF均明显低于正常组,随时间推移逐渐增高,VA、A- VTI、AFF至第7d时基本恢复到正常水平,AEF至除颤后1个月时基本恢复正常。结论　房颤转复后心房收缩功能出现一过性减低;VA、A- VTI、AFF和AEF可用于评价左房收缩功能     

超声心动图对房颤患者复律后心房顿抑的研究

目的应用常规超声心动图及定量组织速度成像技术研究房颤患者电转复后的左房顿抑。方法房颤患者60例,于除颤后1天、3天、7天和1个月时分别行超声心动图检查,记录左房内径、容积、二尖瓣口舒张早期和舒张晚期血流速度VE和VA及二尖瓣环舒张晚期运动速度Va,将除颤后24h与40例正常对照组患者比较;除颤后3天、7天、1个月与除颤后1天比较,进行统计分析。结果房颤患者除颤后VA、VTIA、AFF、AEF、LAAEV、LAAEF、Va均明显减低,随时间推移逐渐增高,30%患者于除颤后7天恢复正常,其余在除颤后1个月完全恢复正常。结论房颤患者除颤后心房功能减低,即出现心房顿抑。     

Doppler sonographic evaluation of left atrial function after cardioversion of atrial fibrillation.

Restoration of sinus rhythm is not always followed by immediate return of effective atrial contraction. Left atrial mechanical function can be assessed by Doppler echocardiography; in the present study we measured the atrial ejection force, which is a noninvasive Doppler-derived parameter that measures the strength of atrial contraction.The aim of the present study was to evaluate the influence of clinical and echocardiographic parameters: duration and cause of atrial fibrillation, different modality of cardioversion, and left atrial size with respect to the delay in the return of effective atrial contraction after cardioversion. Seventy patients were randomly chosen to undergo cardioversion by either direct current shock or intravenously administered procainamide hydrochloride. The 52 patients who had sinus rhythm restored underwent a complete Doppler echocardiographic examination 1 h after the restoration of sinus rhythm and after 1 day, 7 days, and 1 month. The relation between clinical variables and atrial ejection force was tested. Atrial ejection force was greater immediately and 24 h after cardioversion in patients who underwent pharmacologic therapy compared to patients treated with direct current shock (11.3+/-3 versus 5+/-2.9 dynes; P<0.001). In both groups atrial ejection force increased over time. The mode of cardioversion was significantly associated with recovery of left atrial mechanical function by day 1 in univariate and multivariate analysis (odds ratio, 0.14; 95% confidence interval, 0.02-1.2). The other variable associated with the delay in the recovery of atrial function was a dilated left atrium (odds ratio, 0.16; 95% confidence interval, 0.12-1.6). Atrial ejection force is a noninvasive parameter that can be easily measured after cardioversion and gives accurate information about the recovery of left atrial mechanical function. The recovery of left atrial function was influenced by the mode of cardioversion and left atrial size.     

Early recurrence of atrial fibrillation after external cardioversion

Early recurrence of atrial fibrillation (AF) has been reported to occur in a significant number of patients after internal cardioversion. However, information about early recurrence of AF after external cardioversion has never been reported. The present study was conducted to investigate the clinical and electrophysiological characteristics of early recurrence of AF and its role in failure of cardioversion in patients with chronic AF. METHODS AND RESULTS: The study included 50 consecutive patients, age 69+/-9, with a history of chronic AF for more than 3 months duration and electrical cardioversion. They were divided into two groups according to the presence (group 1) or absence (group 2) of early recurrence of AF. There were 13 (26%) patients in group 1 and 37 (74%) patients in group 2. The age, gender, duration of AF, left ventricular function, left atrial dimension, and underlying heart disease were similar between group 1 and 2. Forty-five patients were successfully converted to sinus rhythm with a mean energy of 158+/-57 . Among those who failed to be converted to sinus rhythm, 4 (80%) belonged to group 1 and 1 (20%) belonged to group 2. The early recurrences of AF were initiated with consecutive APDs; but the numbers of APD in the first 30 seconds after cardioversion were similar between group 1 and 2. However, the coupling interval of the second APD was shorter in group 1 than group 2 (188+/-22 vs 324+/-59 ms, P = 0.003). Nine of the 13 early recurrences were prevented by an increase of shock energy (n = 3) or intravenous amiodarone infusion (n = 6). There were no differences in duration of follow-up, recurrence rate, and time interval to recurrence between group 1 and group 2. Early recurrence of AF occurred in 26% of chronic AF patients who underwent external electrical cardioversion and was a major cause of failure in cardioversion. Early recurrence of AF was initiated by APDs with decreasing coupling intervals and could be prevented with an increase of shock energy or amiodarone.     

老年心房颤动患者心脏结构和功能改变的超声心动图分析

目的 观察老年心房颤动（房颤）患者与实性心律患者心脏结构和功能的改变。方法 用多普勒超声心动图技术分析1166例60岁以上老年人的心脏情况；房颤患者与窭性心律患者比较。阵发性房颤患者与持续房颤患者比较。结果 老年房颤患者左心房和左心室扩大。左心室射血分数减低，瓣膜退行性改变及血流动力学改变的发生率高于窦性心律者（P〈0．05或P〈0．01）；老年房颤患者的房室径及面积与窭性心律患者问差异有显著性（P〈0．01）；持续房颤患者的左心房前后径和面积与阵发房颤患者间差异有显著性（P〈0．05）。结论 心脏结构和功能的改变可能是老年房颤发生和发展的危险因素之一。     

氯沙坦联用胺碘酮对预防心房颤动复发及左心房功能影响的研究

目的 观察氯沙坦联用胺碘酮在持续性房颤转复后窦性心律的作用及对左房功能的影响．方法选择持续性房颤患者93例，药物或电复律后随机分2组：对照组予胺碘酮0．2g，1次／d；观察组在服胺碘酮的基础上予血管紧张素受体拮抗剂（氯沙坦）50mg，1次／d，2周后无低血压，第3周加量100mg，1次／d。观察复律后第2天及6、12个月后测定左心房功能变化和房颤复发情况。结果随访1年后，观察组和对照组房颤复发比较有显著性差异（P〈0．05），而左房内径观察组治疗1年后有显著缩小（P〈0．05），对照组上述指标无显著性差异（P〉0．05）。结论氯沙坦联用胺碘酮在持续性房颤转复后维持窦性心律较单用胺碘酮更有效，并可逆转左房扩大。     

Time interval from the initiation of the electrocardiographic P wave to the start of left atrial appendage ejection flow: A novel method for predicting atrial fibrillation recurrence

OBJECTIVE: The incidence of paroxysmal and persistent atrial fibrillation (AF) recurrence is high and unpredictable. In this study, a novel noninvasive method that was thought to reflect the interatrial conduction time was investigated to predict AF recurrence. This method was on the basis of the measurement of time interval from initiation of the electrocardiographic P wave to the start of left atrial (LA) appendage (LAA) ejection flow (P-LAA). Methods and Results: Forty-five consecutive patients (age, 61 +/- 11 years; 20 male) with newly diagnosed AF (mean duration, 132 hours; range: 6 hours-3 months) who converted to in sinus rhythm spontaneously or with cardioversion were studied prospectively. Transthoracic and transesophageal echocardiography were performed to measure LA size, mechanical functions, LAA ejection velocity, and P-LAA. Transesophageal echocardiography was performed for the measurement of P-LAA 1 to 2 days after conversion to in sinus rhythm. The patients were followed up for a period of 163 +/- 72 days for the recurrence of AF. AF recurred in 17 (38%) patients after a mean time of 81 +/- 67 days. P-LAA was significantly higher in patients with AF recurrence (123 +/- 36 vs 92 +/- 24 milliseconds, P =.0047) and multiple regression analysis indicated that P-LAA was an independent predictor of AF recurrence. Multiple regression analysis revealed no significant differences in LA size parameters, or in clinical and LA mechanical function parameters recorded after restoration of in sinus rhythm between patients with and without AF recurrence. CONCLUSION: P-LAA may be considered to be an independent predictor of recurrent AF.     

Left atrial size after cardioversion for atrial fibrillation: effect of external direct current shock.

OBJECTIVE: The aim of this study was to evaluate the effect of external direct current (DC) shock on left atrial (LA) dimension and volumes after cardioversion for atrial fibrillation, and the relation between LA size and atrial function. METHODS: We evaluated 180 patients who were randomly cardioverted with DC shock (90 patients) or drugs (90 patients). Echocardiographic evaluations included LA size and volumes. LA passive and active emptying volumes were calculated, and LA function was measured as atrial ejection force. Changes in LA diameters and volumes were correlate with atrial systolic function. RESULTS: The LA was dilated in all patients during arrhythmia and decreased after the restoration of sinus rhythm. The entity of reduction was different in the 2 groups of patients. LA maximal and minimal volumes were increased after DC shock as compared with patients treated with drugs (LA maximal volume 34 +/- 4 vs 31 +/- 5; P <.01; LA minimal volume 18 +/- 2.6 vs 15 +/- 3.6; P <.01). The atrial function was also depressed after DC shock and the delay in the recovery of atrial contractility was related to LA dilation. Patients treated with drugs had a higher atrial ejection force that was associated with a more marked reduction in LA maximal volume after the restoration of in sinus rhythm. A relationship between LA volumes and atrial ejection force was observed in the group of patients with depressed atrial mechanic function (r = -0.78; P <.001). The active emptying fraction was lower, although not significantly, in this group, whereas the conduit volume was increased. CONCLUSION: External DC shock induced a depressed atrial mechanic function in many patients and this was associated with a persistence of LA dilation.     

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。     

缬沙坦对原发性高血压并阵发性心房颤动患者复率后维持窦性心律的疗效观察

目的 观察缬沙坦对原发性高血压(EH)并阵发性心房颤动(PAF)患者复律后维持窦性心律的疗效及P波最大时限(Pmax)、P波离散度(Pd)、左心房内径(LADd)的影响.方法 选择EH并PAF患者72例,随机分为观察组(缬沙坦+美托洛尔)37例和对照组(氨氯地平+美托洛尔)35例,观察两组治疗12个月后血压、Pmax、Pd、LADd及心房颤动复律后3、6、12个月内窦性心律维持率.结果 治疗前两组的血压、Pmax、Pd、LADd比较差异均无统计学意义(均P ＞0.05).观察组治疗12个月后两组的血压、Pmax、Pd、LADd均显著小于治疗前(P＜0.01);两组治疗后血压差异无统计学意义(均P ＞0.05);观察组的Pmax、Pd、LADd均显著小于对照组,分别为Pmax(113.4±8.3)ms vs (121.7±8.4) ms、Pd(40.6±7.3) ms vs (44.2±6.9) ms、LADd(33.5±1.4) mm vs (35.8±1.5) ms(P＜0.05或＜0.01).治疗组维持窦性心律的例数在6、12个月明显高于对照组(均P＜0.05);两组的不良反应发生率差异无统计学意义(x2 =0.126,P＞0.05).结论 缬沙坦用于EH并PAF复律后维持窦性心律效果良好,可减小Pmax、Pd、LADd,同时可部分预防房颤的发生,其作用独立于降压作用之外,安全性好.