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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
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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]. 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]. 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
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