二维斑点追踪显像及实时三维成像评价阵发性房颤患者射频消融术后左心房结构和功能变化

闫艳; 李新立

二维斑点追踪显像及实时三维成像评价阵发性房颤患者射频消融术后左心房结构和功能变化

闫艳,
李新立

Evaluation of Left Atrial Structure and Function with Two-dimensional Speckle Tracking Imaging and Real-time Three-dimensional Imaging in Patients with Paroxysmal Atrial Fibrillation After Radiofrequency Catheter Ablation

YAN Yan,
LI Xin-li

摘要

摘要:
目的应用二维斑点追踪显像（two-dimensional speckle tracking imaging，STI）及实时三维成像技术（real-time three-dimensional imaging technology，RT-3D）评价阵发性房颤（paroxysmal atrial fibrillation，PAF）患者射频消融术后左心房结构及功能变化，为临床评估手术效果提供依据。
方法选取2016年10月至2017年12月我院行射频消融的PAF患者32例为研究对象，并根据术后是否恢复窦性心律分为窦性心律组（SR组，24例）和房颤复发组（AF组，8例）。PAF患者在术前、术后1、6月行超声心动图检查。应用STI及RT-3D测量左心房内径、容积、左室收缩期、舒张早期、左房收缩期的峰值应变率和射血分数等左心房结构和功能参数。
结果术后1月，SR组左心房最小容积（LAV_min）较术前显著降低（P<0.05），其他参数均无明显变化（P>0.05）；AF组所有参数较术前均无明显变化（P>0.05）。术后6月，SR组患者左心房前后径（LAAPD）、左心房上下径（LAUDD）、左心房左右径（LALRD）、LAV_min、左心房收缩前容积（LAVp）、左心房最大容积（LAV_max）较术前及术后1月均显著减小，左心房射血分数（LAEF）、左心房主动射血分数（LAAEF）、左心房被动射血分数（LAPEF）水平较术前及术后1个月均显著升高，且侧壁基底段、间隔中间段、侧壁中间段的各应变参数（SR_S、SR_E、SR_A）及整体应变参数（GLSR_S、GLSR_E、GLSR_A）较术前及术后1月均升高（P<0.05），侧壁房顶段及间隔房顶段的各应变参数均较术前及术后1月差异无统计学意义（P>0.05）；AF组LAV_min、LAV_max较术前升高，LAEF、LAAEF水平较术前均降低（P<0.05），其他参数均较术前及术后1月差异无统计学意义（P>0.05）。
结论通过STI及RT-3D可以定量分析PAF患者射频消融术前后左心房结构和功能变化，术后恢复窦性心律者，其左心房内径减小，射血分数升高；术后房颤复发者左心房容积增大，心房功能明显减低。

Abstract:
Objective To observe the changes of left atrial structure and function in patients with paroxysmal atrial fibrillation (PAF) after radiofrequency catheter ablation by two-dimensional speckle tracking imaging (STI) and real-time three-dimensional imaging technology (RT-3D) in order to provide basis for clinical evaluation of surgery.
Methods Thirty two (32) cases of PAF patients with catheter ablation from October 2016 to December 2017 in our hospital were enrolled. According to sinus rhythm whether or not be restored after operation, the patients were divided into sinus rhythm group (SR group, 24 cases) and atrial brillation group (AF group, 8 cases). All PAF patients received echocardiography before and 1, 6 months after surgery. Left atrial structure and functional parameters were measured by STI and RT-3D, including left atrial diameter, volume, left ventricular systole, early diastolic, left atrial systolic peak strain rate and ejection fraction.
Results All parameters in AF group were not changed significantly after surgery (P>0.05). In SR group, at 6 month after surgery, the levels of Left atrial anteroposterior diameter (LAAPD), Left atrial up and down diameter (LAUDD), Left atrial left and right diameter (LALRD), minimum volume of left atrium (LAV_min), Left atrial presystolic volume (LAV_p) and max volume of left atrium (LAV_max) were significantly decreased, the levels of Left atrial ejection fraction (LAEF), Left atrial active ejection fraction (LAAEF), Left atrial passive ejection fraction (LAPEF) were significantly increased, the strain rates (SRS, SRE, SRA) in the lateral wall base segment, interval middle segment and middle segment of the lateral wall and overall strain parameters (GLSR_S, GLSR_E, GLSR_A) were significantly increased (all P<0.05); and the other segment strain rates were not significantly changed (P>0.05). In AF group, at 6 month after surgery, the levels of LAV_min, LAV_p and LAV_max were significantly decreased at 6 month after operation, the levels of LAEF, LAAEF were significantly increased, all above had statistical difference (P<0.05); and the other parameters were not significantly changed (P>0.05).
Conclusion STI and RT-3D could quantitatively analyze the structure and function of left atrium before and after radiofrequency ablation in PAF patients. After ablation, the diameter of LA decreases and the ejection fraction increases in the patients with sinus rhythm; the volume of LA increases and the function reduces in the patients with atrial fibrillation recurrence.

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