二维斑点追踪显像对风湿性心脏病重度二尖瓣狭窄合并房颤患者二尖瓣置换及房颤消融术前后左心房应变的研究

目的应用二维超声斑点追踪显像评价风湿性心脏病重度二尖瓣狭窄合并房颤患者二尖瓣置换及房颤消融术前后左心房心肌应变的变化。方法采集25例正常对照组和12例风湿性心脏病重度二尖瓣狭窄合并房颤患者术前、术后1个月、术后3个月的二维动态图像,应用QLab9.0软件测量左心房心肌应变值。结果 (1)与正常对照组相比,风湿性心脏病重度二尖瓣狭窄合并房颤患者左心房整体峰值纵向应变(PALS)减低(P<0.01);左心房整体纵向应变达峰时间(TPLS)延长(P<0.01)。(2)与术前相比,术后1个月PALS增加(P<0.05),整体TPLS缩短(P<0.05);术后3个月PALS增加更为显著(P<0.01),整体TPLS缩短亦更为显著(P<0.01)。结论二维超声斑点追踪显像能快速、准确地定量评价二尖瓣置换及房颤消融术前后左心房功能的变化。

Assessment of left atrial strain in patients with rheumatic heart disease with severe mitral stenosis and atrial fibrillation pre-and post-mitral valve replacement and catheter ablation by using two-dimensional speckle tracking echocardiography

Objective To evaluate the change of left atrial function after mitral valve replacement and catheter ablation in patients with rheumatic heart disease with severe mitral stenosis and atrial fibrillation by measuring left atrial strain using two-dimensional speckle tracking echocardiography （2D-STE）. Methods Study population consisted of 12 patients with rheumatic heart disease with severe mitral stenosis and atrial fibrillation and 25 healthy subjects. High frame rate two-dimensional images were recorded from the apical two chamber view, three chamber view and four chamber view. Images of patients with rheumatic heart disease were respectively recorded at pre-operation, 1 month and 3 months post-operation. Left atrial longitudinal strain was measured in three views using two-dimensional strain software. Results （1） Compared with the control group, global peak atrial longitudinal strain（PALS） decreased（P＆lt;0.01） in patients with rheumatic heart disease, but global time-to-peak of peak atrial longitudinal strain （TPLS） increased （P＆lt;0.01）. （2） Compared with preoperative group, global PALS increased （P＆lt;0.05）, but TPLS decreased （P＆lt;0.05） at 1 month after surgery. Global PALS increased significantly at 3 months after surgery（P＆lt;0.01）, and global TPLS decreased more significantly（P＆lt;0.01）. Conclusion 2D-STE could accurately evaluate the change of left atrial function after mitral valve replacement and catheter ablation.