三维斑点追踪超声心动图评价阵发性房颤患者的左房功能及其与左室充盈压相关性的病例对照研究

 目的 采用三维斑点追踪超声心动图及左房功能定量软件评价阵发性房颤（paroxysmal atrial fibrillation，PAF）患者的左房结构及功能，并观察左房功能与左室充盈压的相关性。方法 本研究为小规模、单中心、病例对照研究，纳入PAF患者，根据年龄和性别匹配健康对照组。在窦性心律状态下，先后采用三维斑点追踪超声心动图、左房定量分析软件及常规超声心动图评价左房结构和功能。结果 PAF组（n=23）平均年龄（66.2±4.3）岁，73.9%为男性；健康对照组（n=23）平均年龄（64.3±7.5）岁，69.6%为男性。PAF组的左房射血分数（45.2%±8.8% vs. 54.0%±7.0%，P<0.01）、峰值左房长轴应变（16.1%±5.4% vs. 20.5%±6.6%，P=0.01）、峰值左房环向应变（21.7%±10.1% vs. 32.8%±7.6%，P<0.01）、舒张早期左房环向应变（-6.9%±5.8% vs. -10.3%±5.0%，P=0.02）和舒张晚期左房环向应变（-14.6%±9.2% vs. -22.1%±7.2%，P=0.01）均显著低于对照组，以上差异与通过二尖瓣多普勒血流早期充盈速度（E峰）、通过二尖瓣多普勒血流晚期充盈速度（A峰）、E峰/A峰比值（E/A）及通过二尖瓣多普勒血流早期充盈速度/室间隔心肌运动速度与侧壁心肌运动速度的平均值（E/e’）差异无相关性。PAF组的左房最大容积［（52.1±14.1）mL vs.（45.3±11.9）mL，P=0.05］、左房最小容积［（29.3±8.7）mL vs.（21.4±6.6）mL，P<0.01］和左房收缩前容积［（43.1±12.4）mL vs.（35.3±9.2）mL，P=0.01］均显著高于健康对照组，与E/A相关（r=0.54，P=0.02；r=0.56，P=0.01；r=0.61，P=0.01）。PAF组的左房最大容积指数高于健康对照组（29.4±7.4 vs. 26.0±6.6，P=0.09），与E峰及E/e’相关（r=0.47，P=0.03；r=0.43，P=0.05）。结论 三维斑点追踪超声心动图可以全面评价PAF患者的左房形态及功能：与健康对照组相比，PAF患者的左房容积明显增加，左房射血分数明显下降，左房纵向和环向变形能力减弱。左房容积参数与左室充盈压变化显著相关。

Assessment of left atrial function and the association with left ventricular filling pressure in patients with paroxysmal atrial fibrillation by threedimensional speckle tracking echocardiography: a case-control study

Objective To evaluate the left atrial(LA)function in paroxysmal atrial fibrillation(PAF) using three-dimensional echocardiography at sinus rhythm,and the correlation between left atrial function and left ventricular filling pressure was observed. Methods This small-scale,single center and casecontrol study included patients with PAF and healthy controls matched by age and gender. LA structure and function were measured by three-dimensional echocardiography and the acquired parameters was analyzed by specific software. Left ventricle structure and function were assessed by conventional echocardiography methods. Results There were 23 cases with average age of(66.2±4.3)years old in PAF group,and 73.9% were male. There were 23 cases with average age of(64.3±7.5)years old in control group,and 69.6% were male. LA ejection fraction(45.2%±8.8% vs. 54.0%±7.0%,P<0.01), peak atrial longitudinal strain(16.1±5.4 vs. 20.5±6.6,P=0.01),peak atrial circumferential strain(21.7±10.1 vs. 32.8±7.6,P<0.01),early diastolic circumferential strain(-6.9±5.8 vs. -10.3±5.0,P=0.02)and late diastolic circumferential strain(-14.6±9.3 vs. -22.1±7.2,P=0.01)were all significantly reduced in PAF group compared with controls group,but not correlated with E/A and E/e'. All LA volume parameters were significantly larger in PAF groupLA maximum volume:(52.1±14.1)mL vs.(45.3±11.9) mL,P=0.05;LA minimum volume:(29.3±8.7) mL vs. (21.4±6.6) mL,P<0.01;pre-LA contractile volume:(43.1±12.4)mL vs.(35.3±9.2)mL,P=0.01]apart from LA maximum volume index which didn't reach a significant level(29.4±7.4 vs. 26.0±6.6,P=0.09). LA maximum volume,LA minimum volume and pre-LA contractile volume were correlated with E/A(r=0.54,P=0.02;r=0.56,P=0.01;r=0.61,P=0.01)while LA maximum volume index was correlated with E and E/e'(r=0.47,P=0.03;r=0.43,P=0.05). Conclusion Three-dimensional speckle tracking evaluates the morphological and functional reconstruction of left atrial in PAF more comprehensively. LA volume of PAF is increased,LA ejection fraction is reduced,the longitudinal and circumferential deformation function of whose are dampened compared with the control ones. LA volume parameters are strongly correlated with filling pressure.