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.     

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。     

经食管超声心动图多参数评估心房颤动患者左心耳功能

目的：探讨三维容积法左心耳排空分数、左心耳壁心肌组织速度在左心耳功能评估中的应用价值。方法连续选取心房颤动患者76例,应用经食管超声心动图测量二维面积法和三维容积法左心耳排空分数、左心耳最大排空流速、以及左心耳三个位点(内、外侧壁中点及尖部)的组织速度,行统计分析。结果①超声检查中心律为窦性者上述6个参数值均高于房颤者(P 均<0.05),不伴左心耳内自发声学显影者6个参数值均高于伴自发声学显影者(P 均<0.05);②三维、二维法排空分数相关性好(r =0.727),且二者与左心耳最大排空流速的相关系数近似(二维法：r =0.685、三维法：r =0.632);③左心耳组织速度中,尖部测值较另两个位点更高(P 均为0.000),且与其他参数的相关性亦更好。结论三维容积法测量左心耳排空分数切实可行,结果可靠;左心耳壁组织速度的最佳取样位点为心耳尖部。     

实时三维经食管超声心动图测定左心耳功能的临床研究

目的 评价实时三维经食管超声心动图(TEE)测定左心耳机械功能的可行性和准确性.方法 对42例心房颤动患者行实时三维TEE检查.分别应用二维面积法、三维面积法和三维容积法测定左心耳排空分数,并与多普勒测定的最大排空速度(PEV)进行相关性分析.检验三种方法的变异性.结果 二维面积法测定的左心耳排空分数高于三维面积法和三维容积法,差异有统计学意义[(62.84±17.27)%对(45.39±16.58)%,P=0.000和(62.84±17.27)%对(48.35±19.37)%,P=0.001],与PEV无显著相关性(r=0.529,P=0.130).三维面积法与三维容积法测定的左心耳排空分数差异无统计学意义[(45.39±16.58)%对(48.35±19.37)%,P=0.158],与PEV有相关关系,r值分别为0.604(P=0.048)和0.662(P=0.036).三种方法的变异性在观察者间和观察者内差异均无统计学意义(P均＞0.05).结论 实时三维TEE测定左心耳排空分数准确可行,优于常规二维面积法,可用于评价左心耳机械功能.     

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。     

组织多普勒与脉冲多普勒Tei指数评价糖尿病右室功能的对比研究

目的：应用组织多普勒（TDI）与脉冲多普勒（PD）测量Tei指数对比评价糖尿病患者的右室功能。方法：测量34例糖尿病患者与34例健康对照者右心常规超声指标,分别采用TDI和PD测量右室Tei指数,分析两种超声检测方法获得的右室Tei指数的相关性。结果：①TDI与PD所测右室Tei指数具有良好的相关性。②糖尿病组的Tei指数明显增大,与对照组比较差异有统计学意义（P<0.01）;③单元线性分析表明：正常对照组中,Tei指数与年龄心率均无相关性（P>0.05）,糖尿病患者中,Tei指数与年龄呈正相关（P<0.05）,而与心率无相关性（P>0.05）。结论：TDI与PD均可作为评价右室Tei指数的简便准确的超声检测方法,且TDI略有优势,是能快速准确评价右室整体功能的较好指标。     

超声心动图评价心房颤动患者左心房及左心耳功能

超声心动图技术为评价心房颤动患者左心房及左心耳功能提供了可能。本文对超声心动图在心房颤动患者左心房及左心耳功能评价中的应用进展进行综述。     

组织多普勒成像技术评估慢性房颤患者左室壁运动

目的 应用组织多普勒成像技术（DTI）探讨慢性房颤患者的室壁运动特点,为临床诊治提供重要的信息,方法,将研究分为三组,A组为18例正常对照,B组为15例心房大小正常的房颤患者,C组为16例心房扩大的房颤患者,所有患者均无严重瓣膜病或节段性室壁运动异常,采用HP SONOS 5500超声显像仪和脉冲DTI,分别在心尖四腔心切面和胸骨旁长轴切面测定左室侧壁和后壁收缩期峰值速度（VS）,舒张期峰值速度（VE）,心电图QRS波起始至收缩期峰值速度的平均时间T1,心电图QRS波起始至舒张期峰值速度的平均时间T2,平均心率为R－R,结果 （1）A组正常人均有舒张早期和晚期两个波峰（E峰和A峰）,B组和C组房颤患者均只有一个舒张期波峰（E峰）,（2）A组与B组这间的DTI测值差异均无显著性意义（均为P＞0．05）,（3）C组左室侧的VS显著小于A组（P＜0．05）,C组左室后壁的VS,VE均显著大于A组（P均＜0．05）,C组侧壁的T1／（R－R）^1/2,Ts/(R-R)1/2显著高于A组（P均＜0．05）,C组后壁的T1／（R－R）^1/2,T2/(R-R)^1/2与A组比较差异无显著性意义（P均＞0．05）,结论 左房增大的房颤患者左室壁在长轴方向收缩活动减弱,舒张期峰值速度延迟,在短轴方向舒缝活动增强,DTI技术能精确地定量分析房颤患者的室壁活动,可成为评价房颤患者心肌舒缩功能的无创伤性新方法。     

TEE结合2D-STI技术探讨房颤患者左心耳功能与射频消融术后房颤复发的关系

目的:应用经食道超声心动图(TEE)探讨房颤(AF)患者左心耳(LAA)功能变化与射频消融术后AF复发的关系。方法:选取2017年2月-2019年4月沈阳医学院附属第二医院心血管内科收治的AF患者68例,所有患者分别于射频消融术前24~48 h、术后24~48 h及3月行TEE检查,术后3月再根据患者复律的情况,分为窦性心律组(A组)及AF复发组(B组),测量患者LAA充盈及排空速率(LAA-Fv、LAA-Ev),LAA最大开口内径(LAA-D),LAA最大深度(LAA-L),LAA射血分数(LAA-EF)及LAA收缩期应变率(LAA-Ssr)等。比较术前、术后各指标的差异并分析其与AF复发的关系。结果:术后24~48 h与术前相比,患者LAA-Fv、LAA-Ev、LAA-EF、LAA-Ssr、LAA-L及LAA-D均未见明显变化(P>0.05);术后3月:A组(51例)与术前相比,LAA-Ev、LAA-Fv、LAA-EF,LAA-Ssr均明显增高,LAA-D明显缩小,差异有统计学意义(P<0.05);B组(17例)与术前相比,LAA-Ev、LAA-Fv、LAA-EF,LAA-Ssr明显降低,LAA-D明显增大,差异有统计学意义(P<0.05),B组另有4例患者LAA内出现血流自发显影(SEC)。二元Logistic回归分析显示LAA-Ev、LAA-Fv、LAA-EF及LAA-Ssr均是AF复发的预测因子,其对应的ROC曲线下面积分别为0.864、0.817、0.803及0.887。结论:LAA-Ev、LAA-Fv、LAA-EF及LAA-Ssr均可作为射频消融术后AF复发的预测因子,且LAA-Ssr的预测效能更优。     

实时三维经食管超声心动图检测心房颤动患者导管消融术后左心耳顿抑的临床研究

目的 探讨非瓣膜病心房颤动(房颤)患者导管消融术后实时三维经食管超声心动图评价左心耳顿抑的价值.方法 28例房颤患者行导管消融术后,分为左心耳顿抑组与对照组,将临床和超声影像学指标作单因素对比分析和相关性研究.结果 左心耳顿抑组与对照组间差异有统计学意义的指标有:房颤持续时间[(16.4±11.6)周对(21.3±18.6)周,P＜0.05]、左心房内径[(43.4±8.3) mm对(47.6±5.9)mm,P＜0.05]、左心房排空分数(0.38±0.04对0.30±0.09,P＜0.05)、左心耳排空分数(0.20±0.03对0.12±0.02,P＜0.001),其中三维容积法测定的左心耳排空分数两组间差异最为显著,左心耳顿抑组中左心耳最大排空速度与左心耳排空分数测定结果呈线性正相关.结论 实时三维经食管超声心动图测定左心耳排空分数准确可行,优于临床和其他超声影像学指标,可用于评估房颤导管消融术后左心耳机械功能障碍.     

Left atrial appendage: morphology and function in patients with paroxysmal and persistent atrial fibrillation

The anatomical and functional characteristics of the left atrial appendage (LAA) and its relationships with anatomical remodeling and ischemic stroke in patients with atrial fibrillation (AF) have not been clearly established. The purpose of this study was to determine whether functional and morphological features of the LAA independently predict clinical outcome and stroke in patients with AF who underwent catheter ablation (CA). Two hundred sixty-four patients with AF, including 176 with paroxysmal AF (PAF, 54.0 ± 11.4 years old, M:F = 138:38) and 88 with persistent AF (PeAF, 56.4 ± 9.6 years old, M:F = 74:14) were studied. Of these patients, 31 (11.7 %) had a history of stroke/TIA (transient ischemic attack). The LA and LAA volumes were 124.0 ± 42.4 and 24.9 ± 4.3 ml in PeAF, these values were greater than those in PAF (81.2 ± 24.8 ml and 21.2 ± 5.1 ml, P < 0.001). The AF type (P = 0.016) and AF duration (P = 0.005), and anti-arrhythmic drugs use (P < 0.001) were significant predictors of AF recurrence after CA in all patients. Compared with patients without history of stroke, stroke patients had larger LA volume (106.9 ± 23.0 vs. 94.0 ± 38.9 ml, P = 0.004) and had lower LAA EF (50.0 ± 11.0 vs. 65.7 ± 13.4 %, P < 0.001). The independent predictors of stroke were age (P = 0.002) and LAA EF (P < 0.001) in PAF patients and that was only age (P = 0.001) in PeAF patients. In anatomical and morphological parameters of the LA and LAA, only depressed systolic function of the LAA was significantly related to stroke/TIA and recurrence of AF after CA in paroxysmal AF patients. Further large scaled prospective study is required for validation.     

Left atrial appendage dysfunction in acute cerebral embolism patients with sinus rhythm: correlation with pulse wave tissue Doppler imaging

To evaluate left atrial appendage (LAA) dysfunction using left atrial pulse-wave tissue Doppler imaging (PW-TDI) in acute cerebral embolism (ACE) patients with sinus rhythm (SR), transthoracic (TTE) and transesophageal echocardiograhy (TEE) were performed in 60 consecutive patients with SR without obvious left ventricular dysfunction within 2 weeks after ACE. Two groups were identified: LAA dysfunction [LAA emptying peak flow velocity (LAA-eV) <0.55 m/s, n = 20, age 65 ± 10 years] and without LAA dysfunction (LAA-eV ≥ 0.55 m/s, n = 40, age 64 ± 10 years) on TEE. Left atrial wall motion velocity (WMV) was obtained from PW-TDI, with the sample volume placed at the left atrial anterior wall adjacent to ascending aortic inferior wall from the long axis view on TTE. WMVs showed triphasic waves: after the P wave (La’) during systole (Ls’), and during early diastole. La’ and Ls’ were significantly lower in the group with versus without LAA dysfunction (4.9 ± 1.4 vs. 7.7 ± 1.8 cm/s, p < 0.0001; 5.3 ± 2.0 vs. 6.7 ± 1.9 cm/s, p < 0.001, respectively) and prevalence of paroxysmal atrial fibrillation, left atrial volume index, and serum levels of brain natriuretic peptide were significantly higher (60 vs. 15 %, p < 0.001; 32 ± 13 vs. 24 ± 13 ml/m², p < 0.05; 174 ± 279 vs. 48 ± 68 pg/ml, p < 0.01, respectively). La’ was an independent predictor of LAA dysfunction (OR 0.380, 95 % CI 0.156–0.925, p < 0.05), and was significantly correlated with LAA-eV (r = 0.594, p < 0.0001) and LAA fractional area change (r = 0.682, p < 0.0001). The optimal cut-off value for LAA-eV < 0.55 m/s was 5.5 cm/s (sensitivity 83 %, specificity 88 %). La’ is a useful and convenient strong predictor of LAA dysfunction in ACE patients with SR.     

Left atrial appendage function in patients with cardioembolic stroke in sinus rhythm and atrial fibrillation.

The purpose of this study was to determine the left atrial appendage (LAA) function in patients with stroke. The study group consisted of 61 patients with stroke and 37 control subjects. Patients with stroke were divided into 2 groups on the basis of the presence of atrial fibrillation (group 1) or sinus rhythm (group 2). Group 1 showed a significant reduction of LAA flow velocities (13.2 +/- 6.4 cm/s versus 27.5 +/- 8 cm/s, P <.05) and significant increase in LAA areas (minimum area: 360.5 +/- 204 mm(2) versus 217.7 +/- 113.9 mm(2), P =.004). Group 2 showed a decrease in LAA flow velocities (17.7 +/- 8.2 cm/s versus 27.5 +/- 8 cm/s, P <.05), but no significant change was found in LAA areas. No significant difference was found in other parameters related to LAA. These findings show that a decreased LAA flow velocity is a risk factor for stroke in patients in sinus rhythm without LAA enlargement. Left atrial appendage area was increased in size only in patients with atrial fibrillation.     

Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

The most severe consequence of atrial fibrillation (AF) is a cardioembolic stroke. The incidence of cardioembolic stroke increases significantly in patients with AF. Although warfarin has been the mainstay of the prevention of cardioembolic stroke, there are several limitations to the use of warfarin that hinder its effectiveness. This article provides the historical development of devices that exclude the left atrial appendage, their effectiveness and potential patient selection, as an alternative to warfarin and the novel oral anticoagulation therapy for the prevention of cardioembolic stroke in patients with AF.     

经食管超声心动图对心房颤动时左心耳血流动力学的研究

目的 研究心房颤动（房颤）时左心耳血流动力学的变化及临床价值。方法 使用多平面经食管超声心动图记录并分析74例房颤患者的左心耳图像、血流频谱及其他相应指标。结果 房颤患者的左心耳最大容积（Vmax-LAA)、左心耳最小容积（Vmin-LAA）均大于窦性心律对照组，左心耳射血分数EF-LAA、左心耳的最大在正向血流速度（V-LAA^ 、最大负向血流速度（V-LAA^-）均小于窦律对照组。其中风湿性心脏病轻度二尖瓣狭窄组与重度二尖瓣狭窄组的上述指标与非风湿性心脏病房颤组均有明显差异，而风湿性心脏病二组间的上述指标无明显差异。Ⅲ型左心耳血流频谱易伴随着较严重的左心耳、左心房的自发性回声（SEC）及血栓形成。结论 多平面经食管超声技术可有效评价房颤时左心耳血流动力学，尤其对房颤早期左房血流动力学及左心房SEC及血栓的早期预防有较实际的应用价值。     

Assessment of left atrial appendage wall velocities by transesophageal tissue Doppler echocardiography: a clinical study in patients with sinus rhythm.

To assess left atrial appendage (LAA) wall velocities, 42 patients in sinus rhythm underwent tissue Doppler interrogation during a clinically indicated transesophageal echocardiography. Color Doppler (B-mode and M-mode) and pulsed Doppler of LAA walls were obtained and analyzed in all patients. Color-coded tissue Doppler rendered a qualitative assessment of LAA wall, depicting both the timing and the sequence of LAA contraction. With pulsed Doppler interrogation, a triphasic signal was recorded in all patients, consisting of a positive wave (D1), followed by a biphasic wave (positive D2 and negative D3). Peak velocities of D1, D2, and D3 were 6.1 +/- 2, 20.1 +/- 7, and 16.1 +/- 5 cm/s, respectively. Mean coefficient of variation of LAA wall velocities was 6%, significantly lower than that of LAA percentage area change (29%). Compared with patients with abnormal relaxation, patients with normal mitral inflow had higher D1 peak velocities (7.3 +/- 1.2 vs 4.3 +/- 1 cm/s, respectively; P <.0001). Time sequence of ECG, LAA flow, and mitral inflow indicates that D1 component of LAA wall occurs in early diastole and is likely due to the upward movement of the mitral ring toward the base of the LAA wall. In conclusion, evaluation of LAA wall using tissue Doppler is feasible and reproducible. Although color tissue Doppler analysis allows a qualitative assessment, pulsed Doppler gives new quantitative insights for the comprehensive assessment of LAA wall dynamics, which complements the information obtained with flow interrogation.     

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。     

Doppler tissue analysis of atrial electromechanical coupling in paroxysmal atrial fibrillation.

The aim of this study was to: (1) evaluate atrial electromechanical coupling using M-mode Doppler tissue; and (2) test its clinical impact for detecting atrial abnormalities in paroxysmal atrial fibrillation (AF). Using Doppler tissue, the time intervals from the onset of P wave until the backward motions of the right and left atrioventricular rings in the apical 4-chamber view corresponding to the atrial contractions were measured. In paroxysmal AF group, these intervals were significantly longer than in the control group. Using the criteria that an abnormal time interval from the onset of P wave until the backward motion of the left atrioventricular ring is longer than 112 milliseconds, the sensitivity, the specificity, and the positive predictive values for paroxysmal AF are 73%, 93%, and 93%, respectively. This parameter is affected in patients with paroxysmal AF and should be useful for detecting atrial impairment related to paroxysmal AF.     

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。     

Relationship between left atrial appendage emptying and left atrial function using cardiac magnetic resonance in patients with atrial fibrillation: comparison with transesophageal echocardiography

To compare cardiac magnetic resonance (CMR) quantifications of left atrium (LA) function and left atrial appendage (LAA) emptying depending on the presence of LA spontaneous echogenic contrast (LA-SEC) on transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF). A total of 48 patients with AF underwent sequential CMR examination and TEE in preparation for catheter ablation. The CMR protocol included cine and velocity encoding (VENC) sequences for evaluation of both LA function and LAA emptying. The peak blood velocity of LAA just before left ventricle systole was defined as the LAA emptying velocity (LAA-EV). Depending on the presence of LA-SEC on TEE, patients were divided into two groups, the SEC group (n?=?15) and the non-SEC group (n?=?33). Mean LAA-EV was significantly greater in the non-SEC group than in the SEC group (54.5?±?24.8 ml/s vs. 26.0?±?22.6 ml/s, P?<?0.01). LAA-EV had a significant positive relationship (P?<?0.05) with LAA backflow velocity, as assessed using TEE. Use of an optimal LAA-EV cutoff value of 35 ml/s to predict LA-SEC yielded a sensitivity of 80.0?%, a specificity of 75.7?%, and positive and negative predictive values of 58.8 and 83.9?%, respectively. Using VENC-CMR, LAA-EV is associated with LA function and can be useful for predicting LA-SEC in patients with AF.