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。

Evaluation of left ventricular function and mechanical dispersion by two-dimensional speckle tracking echocardiography in patients with paroxysmal atrial fibrillation

ObjectiveTo evaluate the left ventricular function and mechanical dispersion (MD) by two-dimensional speckle tracking echocardiography (2D-STE) in patients with paroxysmal atrial fibrillation (PAF). MethodsThirty-seven patients with PAF and 29 controls were selected at the Department of Cardiology of Beijing Chaoyang Hospital Affiliated to Capital Medical University. All subjects underwent transthoracic echocardiography, and two-dimensional ultrasound parameters were routinely measured. Dynamic images of left ventricular apical four-chamber, two-chamber, and three-chamber views were collected as well. EchoPAC 203 software was used to measure the left ventricular myocardium global longitudinal strain (GLS) and longitudinal strain of each segment, and the MD was expressed by the standard deviation of the peak time of each segment. The differences in each parameter between the two groups were analyzed statistically. ResultsLeft atrial diameter (LAD), left atrial volume index (LAVI), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVSd), inter-ventricular septal thickness (IVST), and left ventricular posterior wall thickness (LVPWT) were larger, and left ventricular ejection fraction (LVEF) (59.3±4.7)% vs (63.3±4.0)%] was less in the PAF group than in the control group (P＜0.05 for all). There was no significant difference in the ratio of mitral peak velocity to mitral annulus peak velocity (E/e') between the two groups (P＞0.05).Compared with the controls, the absolute value of GLS was decreased (-17.9±2.3)% vs (-20.7±1.7)%] and MD was increased (59.3±19.6) ms vs (43.0±10.2) ms] in PAF patients. In addition, PAF patients with a normal LA size exhibited significantly lower GLS and increased MD compared with controls (P＜0.05). Conclusion2D-STE can provide valuable information for the evaluation of early impaired left ventricular systolic function in PAF patients, thus providing a reliable basis for early intervention and clinical strategies for them.