Evaluation of left atrial function in patients with coronary artery disease associated with atrial fibrillation by real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging
-
摘要: 目的：探讨实时三维超声心动图（RT-3DE）及二维斑点追踪显像（2D-STI）在评价冠心病合并心房颤动（房颤）患者左房功能中的应用价值。方法：选取30例冠心病合并房颤患者为CAD-AF组、30例冠心病窦性心律患者为CAD-SR组，30例体检正常的健康志愿者作为对照组，行常规二维及多普勒超声测量左房前后径（LAD），二尖瓣口峰值血流速度（E/A），组织多普勒测量二尖瓣后叶瓣环峰值运动速度（e'/a'），应用RT-3DE计算左房最大容积指数（LAVImax）、左房最小容积指数（LAVImin）、左房收缩前容积指数（LAVIp）、左房总射血分数（LATEF）、左房扩张指数（LAEI）、左房被动射血分数（LAPEF）、左房主动射血分数（LAAEF）；应用2D-STI检查，获得左房整体应变-时间曲线，测量左室收缩期、左室舒张早期、左室舒张晚期的左房平均峰值应变（mSs、mSe、mSa）及应变率（mSRs、mSRe、mSRa），并计算左房僵硬度（LASI）。结果：与对照组相比，①CAD-SR组、CAD-AF组的LAD增大，CAD-AF组E/e'速度较对照组及CAD-SR组均有增加（均P<0.05）；②与对照组相比，CAD-SR组、CAD-AF组的LAVImax、LAVImin增大，LATEF、LAEI减小；CAD-SR组LAPEF较对照组减低（均P<0.05）；③与对照组相比，CAD-SR组与CAD-AF组mSs、mSe、mSRs、mSRe减低，LASI增加（均P<0.05），CAD-AF组mSa、mSRa消失；④LASI与LAVImax、LAVImin呈显著正相关，与mSs、mSe、mSRs、mSRe、LATEE、LAEI呈显著负相关（均P<0.05）。结论：RT-3DE及2D-STI可以综合反映冠心病合并房颤患者左房功能的改变。Abstract: Objective: To explore the application of real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI) in the evaluation of left atrial (LA) function in patients with coronary artery disease (CAD) associated with atrial fibrillation (CAD-AF).Method: We selected 30 patients with CAD-AF, 30 patients of CAD with sinus rhythm (CAD-SR) as case group, 30 volunteers of normal physical examination as control group.Standard two-dimensional and doppler ultrasound were used to measure LA diameter (LAD) and peak blood flow velocity of mitral valve (E/A).Pulsed tissue doppler was used to measure peak velocity of mitral valve (e'/a').RT-3DE was used to calculate the maximum LA volume index (LAVImax), the minimum LA volume index (LAVImin), the pre-systolic LA ejection index (LAVIp), the total LA ejection fraction (LATEF), the LA expansion index (LAEI), the LA passive ejection fraction (LAPEF) and the LA active ejection fraction (LAAEF).2D-STI was used to measure the mean peak strain (mSs, mSe, mSa) and strain rate (mSRs, mSRe, mSRa) of LA and LA stiffness index (LASI) was calculated.Result: ①Compared with control group, LAD was increased in CAD-SR group and CAD-AF group, and E and e' velocity was increased in CAD-AF group compared with control group and CAD-SR group (all P<0.05).②Compared with control group, both CAD-SR group and CAD-AF group showed increased LAVImax and LAVImin and decreased LATEF and LAEI.Besides, LAPEF was decreased in the CAD-SR group compared to the control group (all P<0.05).③Compared with control group, both CAD-SR group and CAD-AF group showed decreased mSs, mSRs, mSRe and increased LASI (all P<0.05).Interestingly, mSa and mSRa disappeared in the CAD-AF group.④LASI had a significant positive correlation with LAVImax and LAVImin, and a significant negative correlation with mSs, mSe, mSRs, mSRe, LATEE and LAEI (all P<0.05).Conclusion: RT-3DE and 2D-STI can reflect the changes of left atrial function in patients with coronary artery disease associated with atrial fibrillation.
-
-
[1] Phrommintikul A, Krittayaphong R, Wongcharoen W, et al.Management and risk factor control of coronary artery disease in elderly versus nonelderly:a multicenter registry[J].J Geriatr Cardiol, 2016, 13(12):954-959.
[2] Alexandre J, Saloux E, Chequel M, et al.Preoperative plasma aldosterone and the risk of atrial fibrillation after coronary artery bypass surgery:a prospective cohort study[J].J Hypertens, 2016, 34(12):2449-2457.
[3] Rajabi M, Safarpoor G, Borzou SR, et al.Association between incidence of atrial fibrillation and duration of cardiopulmonary bypass in coronary artery bypass graft surgery(CABG):a cohort study[J].Electronic Physician, 2018, 10(4):6624-6630.
[4] Alasady M, Abhayaratna WP, Leong DP, et al.Coronary artery disease affecting the atrial branches is an independent determinant of atrial fibrillation after myocardial infarction[J].Heart Rhythm, 2011, 8(7):955-960.
[5] Anatoíevna RO, Veniaminovich FO, Mikhaylovich KS.Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft[J].J Geriatr Cardiol, 2016, 13(5):444-449.
[6] 刘鹏, 郑文君, 黄日红, 等.心脏外科术后合并心房颤动治疗的临床研究[J].临床心血管病杂志, 2018, 34(2):175-179.
[7] Heo R, Hong GR, Kim YJ, et al.Automated quantification of left atrial size using three-beat averaging real-time three dimensional Echocardiography in patients with atrial fibrillation[J].Cardiovasc Ultrasound, 2015, 13:38.
[8] Fu H, Liu T, Zhou C, et al.Two-dimensional speckle tracking echocardiography:A novel approach to evaluate left atrial mechanical function[J].Int J Cardiol, 2012, 155(3):481-482.
[9] Khedr L, Elasfar A, Hekal S, et al.Assessment of left and right atrial geometrical changes in patients with stable coronary artery disease:Left and right atrial strain and strain rate imaging study[J].Egypt Heart J, 2018, 70(2):101-106.
[10] Liu YY, Xie MX, Xu JF, et al.Evaluation of left atrial function in patients with coronary artery disease by two-dimensional strain and strain rate imaging[J].Echocardiography, 2011, 28(10):1095-1103.
[11] 褚静洁, 李玉宏.二维斑点追踪显像技术评价冠心病患者左房功能[J].中国医学影像技术, 2011, 27(4):735-738.
[12] Demir M, Aktaş I, Çamci S.Left atrial mechanical function and stiffness in patients with atrial septal aneurysm:a speckle tracking study[J].Cardiol J, 2015, 22(5):535-540.
[13] 罗田田, 张萍, 任建丽, 等.实时三维超声和二维斑点追踪成像对不同时期心房颤动患者左房结构和功能的评价[J].临床心血管病杂志, 2016, 32(5):475-479.
-
计量
- 文章访问数: 123
- PDF下载数: 33
- 施引文献: 0
下载: