CAJ | 학술논문

目的应用实时三维经食管超声心动图(RT-3D TEE)评价非瓣膜病性心房颤动(房颤)患者的左心耳容积和功能.方法随机选取87例经RT-3D TEE检查的患者并将其分为窦性心律、阵发性房颤窦性心律、阵发性房颤的房颤心律和持续性房颤组.对RT-3D TEE获得的左心耳容积及功能参数,采用方差分析LSD方法进行多重比较,对各项参数与左心耳排空指数的相关性采用Pearson相关分析.结果 ①左心耳排空指数与左心耳最小容积呈高度负相关,与左心耳最大容积、开口最大面积及年龄呈低度负相关,与左心耳开口面积变化率及开口最大直径变化率呈高度正相关,与左心耳最大排空流速呈中度正相关,而与开口最大直径无明显相关性.②左心耳自发性显影和血栓形成的发生率随着房颤持续时间的延长而递增.③房颤时间较短且能自主复律或药物复律时,首先发生左心耳最大容积的增大;房颤持续时间增加甚至药物不能复律后,左心耳最小容积增大、开口面积变化率和开口直径变化率变小;房颤持续时间明显增加后,所有容积参数值增大,收缩功能参数值减少.结论 RT-3D TEE能定量分析房颤患者的左心耳容积和功能参数,及其随房颤持续时间和心动周期而变化的特征,对于房颤患者的病情评估及治疗方案的选择具有重要的指导作用.
목적 응용실시삼유경식관초성심동도(RT-3D TEE)평개비판막병성심방전동(방전)환자적좌심이용적화공능.방법 수궤선취87례경RT-3D TEE검사적환자병장기분위두성심률、진발성방전두성심률、진발성방전적방전심률화지속성방전조.대RT-3D TEE획득적좌심이용적급공능삼수,채용방차분석LSD방법진행다중비교,대각항삼수여좌심이배공지수적상관성채용Pearson상관분석.결과 ①좌심이배공지수여좌심이최소용적정고도부상관,여좌심이최대용적、개구최대면적급년령정저도부상관,여좌심이개구면적변화솔급개구최대직경변화솔정고도정상관,여좌심이최대배공류속정중도정상관,이여개구최대직경무명현상관성.②좌심이자발성현영화혈전형성적발생솔수착방전지속시간적연장이체증.③방전시간교단차능자주복률혹약물복률시,수선발생좌심이최대용적적증대;방전지속시간증가심지약물불능복률후,좌심이최소용적증대、개구면적변화솔화개구직경변화솔변소;방전지속시간명현증가후,소유용적삼수치증대,수축공능삼수치감소.결론 RT-3D TEE능정량분석방전환자적좌심이용적화공능삼수,급기수방전지속시간화심동주기이변화적특정,대우방전환자적병정평고급치료방안적선택구유중요적지도작용.
Objective To evaluate the volume and function of left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation using real-time three-dimensional transesophageal echocardiography (RT-3D TEE).Methods Eighty-seven patients underwent RT-3D TEE were divided into 4 groups:patients with normal sinus rhythm group,paroxysmal atrial fibrillation groups with sinus rhythm and with fibrillation,persistent atrial fibrillation group.RT-3D TEE data of left atrial appendage volume and function parameters were derived and analyzed offline with Qlab analysis software.LSD of One-way ANOVA was used to analysis the same parameters among these groups,and Pearson correlation coefficient between ejection fraction (EF) with the other parameters in the fibrillation group were obtained respectively.Results ①The correlation analysis indicated that there was significantly negative correlation between LAA-EF and endsystolic volume (ESV),and there were lower negative correlation among LAA-EF and end-diastolic volume (EDV),LAA maximal area (Amax) and the patients ages.Otherwise,LAA-EF correlated positively with LAA area change percentage (A％),LAA diameter change percentage (D％),and had medium positive correlation with LAA peak emptying velocity(Vep).There was no correlation between LAA-EF and LAA maximal diameter (Dmax).②The change rate of spontaneous echo contrast (SEC) and thrombi of LAA were increasing with duration of atrial fibrillation.③In patients with short-time atrial fibrillation and cardioversion autonomously or after drugs,the enlargement of EDV of the LAA occurred firstly,then ESV,A％ and D％ diminished when drugs was ineffective,lastly,the parameters of volume and contraction declined in patients with persistent atrial fibrillation.Conclusions Quantitative study of the volume and function of LAA by RT-3D TEE,and the relationship between the characteristics of LAA and the duration of atrial fibrillation may offer important information for the evaluation of atrial fibrillation and the choose of treatment protocol.