CAJ | 학술논문

目的应用经食管超声心动图揭示左心耳的功能状态、左心耳内血流动力学的改变,及其对血栓发生高风险的预测价值.方法 89例行经食管超声心动图检查的患者根据左心耳内是否存在自发性显影(SEC)分成SEC组及无SEC组,测量左心耳入口处血流排空峰值速度(LAA-EV)及充盈峰值速度(LAA-FV)、左心耳内侧壁中段收缩峰值速度(LAA-TSV)、舒张峰值速度(LAA-TDV)、左心耳排空血流传播速度(LAA-EPV),观察左心耳内彩色血流多普勒及M型彩色多普勒超声特征.结果 SEC组的LAA-EV、LAA-FV、LAA-TSV、LAA-TDV、LAA-EPV较无SEC组显著降低(P＜0.05);左心耳内血流彩色多普勒信号及M型彩色多普勒超声信号在SEC组有明显差异;随着左心耳功能受损,左心耳M型彩色多普勒超声有4种特征性类型,分别为由心耳尖部向心耳入口处依次排空(N型,正常型),心耳入口排空后紧随尖部排空的逆向排空(R型,逆反型),心耳内垂直线条(V型,垂直型),心耳内未见有效血流信号(S型,淤滞型),其中V、R和S型可能提示血栓形成前的血流动力学改变.LAA-EPV与LAA-EV显著相关(r=0.742,P＜0.001),与LAA-TSV中度相关(r=0.462,P＜0.01),LAA-EV与LAA-TSV显著相关(r=0.600,P＜0.01).结论左心耳功能受损后左心耳室壁运动速度及血流速度显著降低,形成左心耳内血流排空的特征性改变.左心耳的功能异常可能是左心耳内血流淤滞甚至血栓形成的主要原因.特征性血流排空类型V型、R型和S型可能预示血栓形成的高风险.
목적 응용경식관초성심동도게시좌심이적공능상태、좌심이내혈류동역학적개변,급기대혈전발생고풍험적예측개치.방법 89례행경식관초성심동도검사적환자근거좌심이내시부존재자발성현영(SEC)분성SEC조급무SEC조,측량좌심이입구처혈류배공봉치속도(LAA-EV)급충영봉치속도(LAA-FV)、좌심이내측벽중단수축봉치속도(LAA-TSV)、서장봉치속도(LAA-TDV)、좌심이배공혈류전파속도(LAA-EPV),관찰좌심이내채색혈류다보륵급M형채색다보륵초성특정.결과 SEC조적LAA-EV、LAA-FV、LAA-TSV、LAA-TDV、LAA-EPV교무SEC조현저강저(P＜0.05);좌심이내혈류채색다보륵신호급M형채색다보륵초성신호재SEC조유명현차이;수착좌심이공능수손,좌심이M형채색다보륵초성유4충특정성류형,분별위유심이첨부향심이입구처의차배공(N형,정상형),심이입구배공후긴수첨부배공적역향배공(R형,역반형),심이내수직선조(V형,수직형),심이내미견유효혈류신호(S형,어체형),기중V、R화S형가능제시혈전형성전적혈류동역학개변.LAA-EPV여LAA-EV현저상관(r=0.742,P＜0.001),여LAA-TSV중도상관(r=0.462,P＜0.01),LAA-EV여LAA-TSV현저상관(r=0.600,P＜0.01).결론 좌심이공능수손후좌심이실벽운동속도급혈류속도현저강저,형성좌심이내혈류배공적특정성개변.좌심이적공능이상가능시좌심이내혈류어체심지혈전형성적주요원인.특정성혈류배공류형V형、R형화S형가능예시혈전형성적고풍험.
Objective To study the left atrial appendage (LAA) function and haemodynamics by transesophageal echocardiography,and predict high risk of thrombosis.Methods Eighty-nine consecutive patients were studied using transesophageal echocardiography.According to with spontaneous echo contrast (SEC) or not,all patients were divided into SEC group (n =17) and non-SEC group (n-=72).LAA emptying peak flow velocity (LAA-EV),filling peak flow velocity (LAA-FV) were measured by pulsed Doppler.The middle segment of the LAA medial wall systolic peak velocity (LAA-TSV) and diastolic peak velocity (LAA-TDV) were obtained by tissue Doppler imaging.LAA color Doppler and M-mode color Doppler images were acquired and derived the LAA emptying flow propagation velocity (LAA-EPV).Results LAA-EV,LAA-FV,LAA-TSV,LAA-TDV,LAA-EPV of SEC group were lower than those of non-SEC group (P ＜0.05).LAA M-mode color Doppler had four characteristic patterns,N pattern (normal pattern) which flow eject from LAA apical to LAA orifice,R pattern (reverse pattern) which flow eject from LAA orifice to LAA apical,V pattern (vertical pattern) vertical signals seen in systole and without efficient flow,S pattern (stasis pattern) almost no flow signal.V,R and S patterns may indicate high risk of SEC and thrombosis.LAA-EPV had strong correlation with LAA-EV (r =0.742,P ＜0.001),and moderate correlation with LAA-TSV (r =0.462,P ＜0.01),LAA-EV had strong correlation with LAA-TSV (r =0.600,P ＜0.01).Conclusions LAA dysfunction would result in hypokinetic LAA wall motion and reduced blood flow velocity.Emptying abnormalities of LAA might be the important reasons for blood stasis and thrombus formation.Emptying characteristic low patterns of V,R and S might be novel methods to predict high risk of thrombus.