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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (06) : 535 -540. doi: 10.3877/cma.j.issn.1672-6448.2022.06.008

心血管超声影像学

二维斑点追踪超声心动图对阵发性心房颤动患者左心室功能及机械离散度的评价
李沅芝1, 李一丹1, 丁雪晏1, 郭迪晨1, 叶晓光1, 王江涛2, 吕秀章1,()   
  1. 1. 100020 北京,首都医科大学附属北京朝阳医院心脏超声科
    2. 100176 北京,通用电气医疗系统(中国)有限公司
  • 收稿日期:2020-11-23 出版日期:2022-06-01
  • 通信作者: 吕秀章
  • 基金资助:
    首都医科大学附属北京朝阳医院1351人才培养计划(CYMY-2017-28)

Evaluation of left ventricular function and mechanical dispersion by two-dimensional speckle tracking echocardiography in patients with paroxysmal atrial fibrillation

Yuanzhi Li1, Yidan Li1, Xueyan Ding1, Dichen Guo1, Xiaoguang Ye1, Jiangtao Wang2, Xiuzhang Lyu1,()   

  1. 1. Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
    2. General Electric Medical System (China), Beijing 100176, China
  • Received:2020-11-23 Published:2022-06-01
  • Corresponding author: Xiuzhang Lyu
引用本文:

李沅芝, 李一丹, 丁雪晏, 郭迪晨, 叶晓光, 王江涛, 吕秀章. 二维斑点追踪超声心动图对阵发性心房颤动患者左心室功能及机械离散度的评价[J/OL]. 中华医学超声杂志(电子版), 2022, 19(06): 535-540.

Yuanzhi Li, Yidan Li, Xueyan Ding, Dichen Guo, Xiaoguang Ye, Jiangtao Wang, Xiuzhang Lyu. Evaluation of left ventricular function and mechanical dispersion by two-dimensional speckle tracking echocardiography in patients with paroxysmal atrial fibrillation[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(06): 535-540.

目的

应用二维斑点追踪超声心动图(2D-STE)评价阵发性心房颤动(PAF)患者左心室功能及机械离散度(MD)。

方法

回顾性选取2019年10月至2020年11月于首都医科大学附属北京朝阳医院心内科确诊的PAF患者37例,同时选取健康对照组29例。所有研究对象均行经胸超声心动图检查,常规测量二维超声心动图参数,并采集左心室心尖四腔心、两腔心及三腔心切面动态图像,应用2D-STE测量左心室各节段及整体纵向应变(GLS),以各节段应变达峰时间标准差表示MD。评价各参数的组间差异,并进行可重复性分析。

结果

PAF组左心房内径(LAD)、左心房容积指数(LAVI)、左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVSd)、室间隔厚度(IVST)及左心室后壁厚度(LVPWT)均较对照组增大(P均<0.05),左心室射血分数(LVEF)较对照组减低[(59.3±4.7)% vs(63.3±4.0)%,P<0.05]。与对照组相比,PAF组左心室GLS绝对值减低[(-17.9±2.3)% vs(-20.7±1.7)%,P<0.05]、MD增加[(59.3±19.6)ms vs(43.0±10.2)ms,P<0.05]。与对照组相比,左心房未扩大的PAF患者已出现GLS降低、MD增大,差异均有统计学意义(P均<0.05)。GLS和MD观察者内和观察者间ICC均>0.80。

结论

PAF患者存在左心室收缩功能早期受损,2D-STE可为其评估提供有价值的信息,从而为PAF患者的早期干预和临床决策提供可靠依据。

Objective

To evaluate the left ventricular function and mechanical dispersion (MD) by two-dimensional speckle tracking echocardiography (2D-STE) in patients with paroxysmal atrial fibrillation (PAF).

Methods

Thirty-seven patients with PAF and 29 controls were selected at the Department of Cardiology of Beijing Chaoyang Hospital Affiliated to Capital Medical University. All subjects underwent transthoracic echocardiography, and two-dimensional ultrasound parameters were routinely measured. Dynamic images of left ventricular apical four-chamber, two-chamber, and three-chamber views were collected as well. EchoPAC 203 software was used to measure the left ventricular myocardium global longitudinal strain (GLS) and longitudinal strain of each segment, and the MD was expressed by the standard deviation of the peak time of each segment. The differences in each parameter between the two groups were analyzed statistically.

Results

Left atrial diameter (LAD), left atrial volume index (LAVI), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVSd), inter-ventricular septal thickness (IVST), and left ventricular posterior wall thickness (LVPWT) were larger, and left ventricular ejection fraction (LVEF) [(59.3±4.7)% vs (63.3±4.0)%] was less in the PAF group than in the control group (P<0.05 for all). There was no significant difference in the ratio of mitral peak velocity to mitral annulus peak velocity (E/e') between the two groups (P>0.05).Compared with the controls, the absolute value of GLS was decreased [(-17.9±2.3)% vs (-20.7±1.7)%] and MD was increased [(59.3±19.6) ms vs (43.0±10.2) ms] in PAF patients. In addition, PAF patients with a normal LA size exhibited significantly lower GLS and increased MD compared with controls (P<0.05).

Conclusion

2D-STE can provide valuable information for the evaluation of early impaired left ventricular systolic function in PAF patients, thus providing a reliable basis for early intervention and clinical strategies for them.

表1 PAF组与对照组一般资料比较
表2 PAF组与对照组常规超声心动图参数比较
表3 左心房大小正常及扩大的PAF组与对照组左心室功能参数比较(
xˉ
±s
图1 左心室心肌纵向应变曲线及牛眼图。图a示健康者左心室心肌整体纵向应变(GLS)为-23.4%、纵向应变达峰时间离散度(MD)为53.7 ms;图b示阵发性心房颤动患者左心室GLS为-19.1%、MD为65.8 ms
表4 左心室功能参数的观察者内和观察者间可重复性分析
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