多普勒组织成像对心房纤颤射频消融治疗前后心房肌运动速度、应变及应变率变化的研究

目的探讨定量多普勒组织成像技术(DTI)在心房纤颤患者行射频消融(RFCA)治疗前后心房肌组织运动变化的特点。方法在15例正常体检者(对照组)及26例心房纤颤患者(AF组),RFCA术后3个月AF复发组及维持窦性心律组,应用DTI技术观察左心房侧壁、左心房后壁、左心房前壁、右心房游离壁、房间隔中部收缩期最大心肌运动速度、应变和应变率,以及左心耳入口处峰值血流速度(充盈峰速度和排空峰速度)的变化。结果 AF组左心房内径与对照组相比明显增大(P0.01);左心耳排空速度及其时间速度积分明显降低(P0.05);心房肌局部应变、应变率在收缩期峰值明显减低(P0.01);心房肌运动速度除右心房游离壁外,余部位均明显降低(P0.01)。RFCA术后3个月维持窦性心律组、AF复发组与对照组比较,左心房内径的改变具有统计学意义(P0.05或P0.01),左心耳排空峰值流速明显增高(P0.05);维持窦性心律组与AF复发组比较,收缩期峰值速度有所增加,但没有统计学意义(P0.05),应变和应变率明显增大并且具有统计学意义(P0.05或P0.01)。结论 AF患者RFCA术后左心耳血流排空速度、心房应变和应变率较高者具有较大的维持窦性心律的可能性;窦性心律的维持与左心房内径明显减小有关。

The study on atrial velocity strain and strain rate in the patients with atrial fibrillation before and after radiofrequency catheter ablation by Doppler tissue image

Objective To study the atrial myocardial properties in patients with atrial fibrillation （AF） before and after radiofrequency ablation in healthy subjects were applied with by myocardial velocity, strain rate, and strain. Methods Twenty-six AF patients and fifteen healthy subjects were applied with transtharacic echocardiography （ TI＇E）, transesophageal echocardiography （ TEE ）, and myocardial velocity and strain and strain rate imaging examinations before and after successful RFCA. The left ventricular（LA） septum, LA lateral wall, right atrial free wall LA posterior wall and LA anterior wall were analyzed. LA ap- pendage flow was obtained by placing the pulsed Doppler sample volume at the orifice of the left atrial ap- pendnge （LAA） and peak flow velocities were measured. The above parameters were analyzed statistically. Results Compared with healthy subjects, AF patients had larger LA dimensions （P 〈 0.01 ）. Emptying flow velocity of LAA and its TVI were significantly decreased （ P 〈 0. 05 ）. Peak systolic atrial myocardial strain and strain rate values in each studied atrial wall were significantly decreased（ P 〈 0.01 ）. Peak systolic and early diastolic atrial myocardial velocity in each atrial wall studied excluding early diastolic atrial myocar- dial velocities of right atrial free wall were significantly decreased （P 〈 0.01 ）. Compared with the AF recur- rence group in sinus rhythm group and healthy group, LA diamet/~r had significantly difference （P 〈 0.05 or P〈0.01 ）. Peak systolic atrial myocardial velocities were increased without significant differences（P 〉 0.05）. Peak systolic atrial myocardial strain and strain rate values in each atrial wall studied were signifi- cantly increased （P 〈 0.05 or P 〈 O. 01 ）. Conclusions A significant relationship between the maintenance of sinus rhythm and LA size was found. The patients with higher emptying flow velocity of LAA, atrial strain and strain rate have a greater possibility of stable sinus rhythm.