切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (12) : 1323 -1328. doi: 10.3877/cma.j.issn.1672-6448.2022.12.002

心血管超声影像学

压力-应变环对射血分数正常的心房颤动患者射频消融术前后左心室心肌做功的评价
伍婷婷1, 解翔1,†(), 姜凡1, 方思华1, 胡萍1, 郭文池1   
  1. 1. 230601　合肥，安徽医科大学第二附属医院超声诊断科
  • 收稿日期:2021-04-20 出版日期:2022-12-01
  • 通信作者: 解翔
  • 基金资助:
    安徽省高校自然科学研究项目(KJ2020ZD22)

Evaluation of left ventricular myocardial work by pressure-strain loop in atrial fibrillation patients with normal left ventricular ejection fraction before and after catheter ablation

Tingting Wu1, Xiang Xie1,†(), Fan Jiang1, Sihua Fang1, Ping Hu1, WenChi. Guo1   

  1. 1. Department of Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
  • Received:2021-04-20 Published:2022-12-01
  • Corresponding author: Xiang Xie
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

伍婷婷, 解翔, 姜凡, 方思华, 胡萍, 郭文池. 压力-应变环对射血分数正常的心房颤动患者射频消融术前后左心室心肌做功的评价[J/OL]. 中华医学超声杂志（电子版）, 2022, 19(12): 1323-1328.

Tingting Wu, Xiang Xie, Fan Jiang, Sihua Fang, Ping Hu, WenChi. Guo. Evaluation of left ventricular myocardial work by pressure-strain loop in atrial fibrillation patients with normal left ventricular ejection fraction before and after catheter ablation[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(12): 1323-1328.

目的

应用左心室压力-应变环（PSL）量化评价左心室射血分数（LVEF）正常的心房颤动患者射频消融术前、术后的左心室心肌做功指数。

方法

这是一项回顾性研究。选取2020年1月至2020年12月于安徽医科大学第二附属医院就诊的LVEF正常的持续性心房颤动患者37例，所有患者均行心房颤动射频消融术。另选取同期37例健康者为对照组。所有心房颤动患者均在射频消融术前及术后3~6个月内行超声心动图检查。采集并获取心房颤动患者及对照组的常规超声心动图参数，以及左心室整体纵向应变（GLS）、整体做功指数（GWI）、整体有效功（GCW）、整体无效功（GWW）、整体做功效率（GWE），分析比较心房颤动患者术前、术后及对照组3组的常规超声心动图参数以及压力-应变参数的差异。

结果

心房颤动患者术前、术后及对照组LVEF比较，差异无统计学意义（P＞0.05）。心房颤动组术前GLS、GWI、GCW及GWE低于对照组，GWW高于对照组，差异均有统计学意义（P均＜0.05）。与术前比较，心房颤动组射频消融术后的GLS、GWI、GCW及GWE升高，GWW减低（P均＜0.05）；术后参数与对照组比较，GLS、GWI、GCW差异均无统计学意义（P均＞0.05）；但GWW高于对照组、GWE低于对照组，差异均有统计学意义（P均＜0.05）。

结论

PSL可以定量评估LVEF正常的心房颤动患者术前及术后的左心室心肌做功改变，早期检测持续性心房颤动患者的心肌受损情况。早期行射频消融术恢复窦性心律，可以有效改善此类患者早期心肌受损。

关键词: 心房颤动, 左心室功能, 压力-应变环, 心肌做功, 导管消融术
Objective

To quantitatively evaluate the left ventricular myocardial work by pressure-strain loop (PSL) before and after catheter ablation in atrial fibrillation patients with normal left ventricular ejection fraction (LVEF).

Methods

This was a retrospective observational study in which 37 patients with persistent atrial fibrillation receiving catheter ablation from January 2020 to December 2020 at the Second Affiliated Hospital of Anhui Medical University, and 37 healthy subjects were included. All the patients underwent echocardiography before and 3-6 months after ablation. Routine echocardiographic parameters and global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were compared among patients before ablation, those after ablation, and healthy subjects.

Results

There was no significant difference in LVEF among the three groups (P＞0.05). Preoperative GLS, GWI, GCW, and GWE in the atrial fibrillation group were significantly lower than those in the control group, and GWW was significantly higher than that of the control group (P＜0.05 for all). After catheter ablation, GLS, GLS, GWI, GCW, and GWE in the atrial fibrillation group were significantly higher than those before surgery, and GWW was significantly lower than that before surgery (P＜0.05 for all). Compared with the control group, there were no significant differences in GLS, GWI, or GCW in the atrial fibrillation group (P＞0.05), but GWW was significantly higher and GWE was significantly lower than that of control group (P＜0.05 for both).

Conclusion

PSL can quantitatively evaluate the changes of left ventricular myocardial function in atrial fibrillation patients with normal LVEF before and after surgery, and detect myocardial damage in these patients early. Early radiofrequency ablation to restore sinus rhythm can effectively improve the early myocardial damage in these patients.

Key words: Atrial fibrillation, Left ventricular function, Pressure-strain loop, Myocardial work, Catheter ablation
表1 心房颤动组与对照组一般资料比较（
xˉ
±s）
组别 例数 年龄（岁） 身高（cm） 体重（kg） BMI 收缩压（mmHg） 舒张压（mmHg）
对照组 37 58.00±9.93 163.70±7.07 66.19±10.79 24.59±2.99 126.81±13.40 76.00±9.12
心房颤动组 37 60.14±12.23 164.19±7.43 66.51±9.02 24.62±2.63 125.76±13.94 76.43±11.20
t值 -0.825 -0.289 -0.140 -0.054 0.332 -0.182
P值 0.412 0.774 0.889 0.957 0.741 0.856
表2 心房颤动组术前、术后与对照组的常规超声心动图测量参数比较（
xˉ
±s）
组别 例数 LVDd（mm） IVS（mm） LVPW（mm） LAD（mm） LVEF（%）
对照组 37 45.51±2.83 9.54±1.84 8.97±1.38 34.97±3.39 60.54±5.44
心房颤动组
术前 37 46.84±4.19 9.22±1.13 8.70±0.94 39.54±6.33a 58.56±5.03
术后 37 46.79±3.94 9.17±1.11 8.73±0.96 36.86±4.06 ab 61.51±5.57
F值 1.514 0.779 0.661 7.648 2.941
P值 0.225 0.441 0.519 0.001 0.059
表3 心房颤动组射频消融术前、术后与对照组的压力-应变测量参数比较（
xˉ
±s）
组别 例数 GLS（-%） GCW（mmHg%） GWI（mmHg%） GWW（mmHg%） GWE（%）
对照组 37 19.98±1.42 2219.16±329.97 2081.57±308.35 145.81±71.91 92.78±2.98
心房颤动组
术前 37 16.14±3.06 a 1855.43±491.58 a 1638.73±457.94 a 299.81±123.85 a 83.320±6.32 a
术后 37 19.23±1.93b 2115.86±427.70b 1950.76±434.89b 180.86±65.82 ab 89.94±3.79 ab
F值 30.458 7.310 11.634 29.1113 41.366
P值 0.000 0.001 0.000 0.000 0.000
图1 左心室17节段心肌做功图。图a~c分别为心房颤动患者射频消融术前、术后及健康对照者心肌做功图像
1
李沅芝, 李一丹, 郭迪晨, 等. 超声心动图评价心房颤动患者左心结构和功能的应用进展[J]. 临床超声医学杂志, 2020, 22(9): 688-690.
2
Hubert A, Le Rolle V, Leclercq C, et al. Estimation of myocardial work from pressure-strain loops analysis: an experimental evaluation[J]. Eur Heart J Cardiovasc Imaging, 2018, 19(12): 1372-1379.
3
中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会, 中国房颤中心联盟心房颤动防治专家工作委员会. 心房颤动:目前的认识和治疗建议(2021)[J]. 中华心律失常学杂志, 2022, 26(1): 15-88.
4
Luis SA, Chan J, Pellikka PA. Echocardiographic assessment of left ventricular systolic function: an overview of contemporary techniques, including speckle-tracking echocardiography[J]. Mayo Clin Proc, 2019, 94(1): 125-138.
5
Jahn L, Kramann R, Marx N, et al. Speckle tracking echocardiography and all-cause and cardiovascular mortality risk in chronic kidney disease patients[J]. Kidney Blood Press Res, 2019, 44(4): 690-703.
6
Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ, et al. Global longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population: the copenhagen city heart study[J]. Circ Cardiovasc Imaging, 2016, 67(13): 1584-1584.
7
Duchenne J, Turco A, Unlu S, et al. Left ventricular remodeling results in homogenization of myocardial work distribution[J]. Circ Arrhythm Electrophysiol, 2019, 12(5): e005521-e005521.
8
Russell K, Eriksen M, Aaberge L, et al. A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work[J]. Eur Heart J, 2012, 33(6): 724-733.
9
Galli E, Vitel E, Schnell F, et al. Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis[J]. Echocardiography, 2019, 36(1): 74-82.
10
Russell K, Eriksen M, Aaberge L, et al. Assessment of wasted myocardial work: a novel method to quantify energy loss due to uncoordinated left ventricular contractions[J]. Am J Physiol Heart Circ Physiol, 2013, 305(7): H996-H1003.
11
Ke QQ, Xu HB, Bai J, et al. Evaluation of global and regional left ventricular myocardial work by echocardiography in patients with chronic kidney disease[J]. Echocardiography, 2020, 37(11): 1784-1791.
12
柴玉娇, 袁建军, 朱好辉, 等. 超声压力-应变环技术评价乳腺癌化疗后心肌做功能力的改变[J]. 中国医学影像学杂志, 2020, 28(10): 757-760.
13
Wang RR, Tian T, Li SQ, et al. Assessment of left ventricular global myocardial work in patients with different degrees coronary artery stenosis by pressure-strain loops analysis[J]. Ultrasound Med Biol, 2021, 47(1): 33-42.
14
Montgomery JA, Abdallah W, Yoneda ZT, et al. Measurement of diffuse ventricular fibrosis with myocardial T1in patients with atrial fibrillation[J]. J Arrhythm, 2016, 32(1): 51-56.
15
Kowalik E, Kowalski M, Klisiewicz A, et al. Global area strain is a sensitive marker of subendocardial damage in adults after optimal repair of aortic coarctation: three -dimensional speckle tracking echocardiography data [J]. Heart Vessels, 2016, 31(11): 1790-1797.
16
Kawakami T, Ohno H, Tanaka N, et al. The relationship between paroxysmal atrial fibrillation and coronary artery spasm[J]. Pacing Clin Electrophysiol, 2014, 37(5): 591-596.
17
徐娟, 李晓旋, 辛恺, 等. 自动功能成像技术评价左室射血分数正常房颤患者的左室收缩功能[J].中国临床医学影像杂志, 2020, 31(4): 258-260, 280.
[1] 陈芬, 葛贝贝, 王小贤, 李明霞, 徐芳, 史坚, 郭冠军, 方爱娟, 史中青, 戚占如, 陈慧, 姚静. 左束支传导阻滞性心肌病心脏电-机械重构的实验研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(10): 978-985.
[2] 卢天祺, 张巍, 周康, 毕士玉, 张羽, 杨秀华. 血流向量成像技术在不同Child-Pugh分级乙肝患者左心功能评价中的价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(04): 352-360.
[3] 冯敏, 赵博文, 潘美, 彭晓慧, 陈冉, 毛彦恺, 陈阳. 超声心动图定量右心时间间期在评估右心室流出道梗阻性疾病胎儿右心功能中的应用研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(02): 151-157.
[4] 张胜男, 苗雅敬, 周虹, 韩高洁, 王静, 仝巧立, 张旭倩, 尹洪宁. 左心耳三维经食管超声测量与Watchman左心耳封堵器大小的相关性研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(02): 107-113.
[5] 陈佳易, 袁帅, 胡胜男, 步笑辉, 牟芸, 郑哲岚. 左心室压力-应变环联合Tei指数评价慢性中重度主动脉瓣反流患者左心功能的初步研究[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(12): 1231-1236.
[6] 吴文娟, 王小莉, 刘娟. 乳腺结节微创手术治疗进展研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(02): 229-232.
[7] 张煜彭, 李浩南, 付焱, 冯继伟, 刘凯, 张文凯. 术后房颤对老年髋部骨折患者预后影响的研究进展[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(01): 51-56.
[8] 黄淑萍, 龚蓓, 申铁梅, 杨丹莉, 陈秀梅, 李国琪, 李星, 麦爱欢, 钟冰, 广东省护士协会心血管疾病护理分会, 南方心血管护理联盟. 心房颤动患者介入手术围术期护理专家共识[J/OL]. 中华介入放射学电子杂志, 2024, 12(01): 1-9.
[9] 付明鹏, 牛国栋, 岑志富, 乔宇, 郭金锐, 郭雨龙, 谢阳, 刘晨, 袁华苑, 刘可, 何姗姗. 三维标测系统指导下国产花瓣状脉冲电场消融系统应用一例[J/OL]. 中华心脏与心律电子杂志, 2024, 12(03): 180-184.
[10] 储慧民, 杜先锋. 心腔内超声心动图指导左心耳封堵的规范化标准流程[J/OL]. 中华心脏与心律电子杂志, 2024, 12(01): 1-5.
[11] 储慧民. 心腔内超声心动图指导下的左心耳封堵术标准流程解析[J/OL]. 中华心脏与心律电子杂志, 2024, 12(01): 58-58.
[12] 文明, 张丽, 谢芳, 艾克拜尔·艾力, 克力木·阿不都热依木. 构建胃食管反流病患者发生心房颤动的临床预测模型[J/OL]. 中华胃食管反流病电子杂志, 2024, 11(03): 130-136.
[13] 古丽尼格尔·吾布力, 印纹源, 冯艳, 买买提·依斯热依力, 克力木·阿不都热依木, 夏木西娅·哈德尔. 探讨胃食管反流病与心房颤动、酸反流及食管运动特征的相关性[J/OL]. 中华胃食管反流病电子杂志, 2024, 11(01): 31-36.
[14] 郑屹, 刘莹, 张煜坤, 李广平, 陈康寅, 刘彤. 既往及新发心房颤动对急性心肌梗死患者远期卒中风险的影响[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 406-417.
[15] 李芳, 戴西望, 王凯, 郭廷昊, 涂江龙. 非瓣膜性心房颤动相关性卒中的治疗研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 393-397.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号

AI
小
编
AI小编
你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？