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) : 1336 -1341. doi: 10.3877/cma.j.issn.1672-6448.2022.12.004

心血管超声影像学

心房颤动患者冷冻消融联合左心耳封堵术后左心房结构和功能的超声心动图评价
郑雨萌1, 丁明岩2, 郭丽娟2, 张慧慧2, 李颖2, 赵含章2, 朱芳2,†()   
  1. 1. 116044　大连医科大学研究生院影像医学与核医学系；110016　沈阳，辽宁省人民医院心功能科
    2. 110016　沈阳，辽宁省人民医院心功能科
  • 收稿日期:2021-06-21 出版日期:2022-12-01
  • 通信作者: 朱芳

Evaluation of left atrial structural and function by echocardiography in patients with atrial fibrillation after combined catheter ablation and left atrial appendage closure

Yumeng Zheng1, Mingyan Ding2, Lijuan Guo2, Huihui Zhang2, LiYing2, Hanzhang Zhao2, Fang Zhu2,†()   

  1. 1. Faculty of Medical Imaging and Nuclear Medicine, Graduate School of Dalian Medical University, Dalian 116044, China; Department of Cardiac Function, People's Hospital of Liaoning Province, Shenyang 110016, China
    2. Department of Cardiac Function, People's Hospital of Liaoning Province, Shenyang 110016, China
  • Received:2021-06-21 Published:2022-12-01
  • Corresponding author: Fang Zhu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

郑雨萌, 丁明岩, 郭丽娟, 张慧慧, 李颖, 赵含章, 朱芳. 心房颤动患者冷冻消融联合左心耳封堵术后左心房结构和功能的超声心动图评价[J]. 中华医学超声杂志（电子版）, 2022, 19(12): 1336-1341.

Yumeng Zheng, Mingyan Ding, Lijuan Guo, Huihui Zhang, LiYing, Hanzhang Zhao, Fang Zhu. Evaluation of left atrial structural and function by echocardiography in patients with atrial fibrillation after combined catheter ablation and left atrial appendage closure[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(12): 1336-1341.

目的

应用超声心动图评价阵发性心房颤动患者冷冻消融联合左心耳封堵（CA+LAAC）术前、术后左心房结构和功能的变化。

方法

选取2019年9月至2021年3月于辽宁省人民医院行“一站式”手术（CA+LAAC）的患者26例。所有患者分别于术前1周内、术后3个月行超声心动图检查评价左心房的结构和功能。行常规超声心动图检查，测量常规超声心动图参数：左心房前后径（LAD）、左心房最大容积（LAVmax）、左心房最小容积（LAVmin）、左心室射血分数（LVEF）、左心室舒张早期二尖瓣口血流速度（E峰）、二尖瓣环侧壁和房间隔侧舒张早期运动速度的平均值（e'）。并计算左心房最大容积指数（LAVImax）、左心房最小容积指数（LAVImin）、左心房射血分数（LAEF）、左心房扩张指数（LAEI）及E/e'。应用二维斑点追踪超声心动图（2D-STI）在心尖四腔心和心尖两腔心切面测量左心房应变参数：心室收缩期左心房储备期纵向峰值应变（PALSres），心室舒张早期左心房管道期纵向峰值应变（PALScond）及心室舒张晚期左心房泵功能期纵向峰值应变（PALSpump）。采用配对样本t检验比较术前与术后3个月超声心动图参数。

结果

与术前相比，CA+LAAC手术后3个月，LAD、LAVmax、LAVmin、LAVImax、LAVImin减小，差异均有统计学意义（P均＜0.05），LAEF、LAEI、LVEF，PALSres、PALScond、PALSpump与术前相比均增大，差异均有统计学意义（P均＜0.05）。

结论

CA+LAAC术后3个月，阵发性心房颤动患者左心房的结构和功能均得到改善和恢复，超声心动图对于评估心房颤动患者左心房结构和功能具有良好的应用价值。

关键词: 心房颤动, 左心房, 超声心动图, 二维斑点追踪成像, 导管消融术, 左心耳封堵术

To evaluate left atrial structural and function changes using echocardiography in patients with paroxysmal atrial fibrillation before and after combined catheter ablation and left atrial appendage closure (CA+LAAC) as "one-stop" procedure.

Methods

We selected 26 patients who underwent the "one-stop" procedure at People's hospital of Liaoning province from September 2019 to March 2021 and evaluated their left atrial structural and function changes by echocardiography preoperatively and 3 months after "one-stop" procedure. Left atrial anteroposterior diameter (LAD), left ventricle diameter (LVD), left atrial maximum volume (LAVmax), left atrial minimum volume (LAVmin), left ventricular ejection fraction (LVEF), mitral valve inflow peak spectral velocity in left ventricular early diastole (E-wave), and the average of tissue velocity of mitral annulus on the ventricular septum and tissue velocity of mitral annulus on the lateral wall in left ventricular early diastole (e') were obtained by echocardiography. Left atrial maximum volume index (LAVImax), left atrial minimum volume index (LAVImin), left atrial ejection fraction (LAEF), left atrial expansion index (LAEI), and average E/e' value were calculated by conventional echocardiography. The peak longitudinal strain of the left atrium during reservoir phase (PALSres), the peak longitudinal strain of the left atrium during conduit phase (PALScond), and the peak longitudinal strain of the left atrium during booster pump phase (PALSpump) were measured using two-dimensional speckle tracking imaging (2D-STI) in the apical views of four and two chambers. The changes of left atrial structure and function in patients with paroxysmal atrial fibrillation before and after "one-stop" procedure were compared using the paired t test.

Results

Compared to preoperative values, LAD, LAVmax, LAVmin, LAVImax, and LAVImin significantly decreased at 3 months after the "one-stop" procedure (P＜0.05 for all), while LAEF, LAEI, LVEF, PALSres, PALScond, and PALSpump increased significantly (P＜0.05 for all).

Conclusion

The left atrial structure and function in patients with paroxysmal atrial fibrillation after CA+LAAC recover three months after the "one-stop" procedure. Echocardiography has important clinical value in evaluating the changes of left atrial structure and function in patients with paroxysmal atrial fibrillation.

Key words: Atrial fibrillation, Left atrium, Echocardiography, Two-dimensional speckle tracking imaging, Catheter ablation, Left atrial appendage closure
表1 术前与术后3个月常规超声心动图参数比较（
xˉ
±s，n=26）
参数 术前 术后3个月 P值
LAD（mm） 43.23±5.29 41.73±4.83 0.001
LVD（mm） 45.62±3.48 46.81±3.31 0.061
E（cm/s） 87.46±19.57 79.08±22.79 0.079
EDV（ml） 90.50±11.59 92.69±14.57 0.246
LVEF（%） 53.46±3.63 56.15±2.44 0.001
E/e' 11.16±2.35 10.24±2.34 0.085
表2 术前与术后3个月超声心动图容积参数比较（
xˉ
±s，n=26）
参数 术前 术后3个月 P值
LAVmax（ml） 74.09±15.00 68.53±15.39 0.001
LAVmin（ml） 51.98±15.01 45.79±13.00 0.000
LAVImax（ml/m2） 41.14±8.12 38.08±8.33 0.001
LAVImin（ml/m2） 28.95±8.41 25.50±7.38 0.000
LAEF（%） 30.81±8.71 34.08±7.26 0.002
LAEI（%） 46.88±19.45 53.73±17.26 0.002
表3 术前与术后3个月的2D-STI左心房应变参数比较（%，
xˉ
±s，n=26）
参数 术前 术后3个月 P值
PALSres 14.10±7.43 24.84±5.97 ＜0.001
PALScond 7.48±3.80 12.42±3.02 ＜0.001
PALSpump 6.69±3.73 12.42±4.21 ＜0.001
图1 阵发性心房颤动患者术前与术后二维斑点追踪超声心动图图像。图a为术前四腔心切面左心房纵向应变曲线图；图b为术后3个月四腔心切面左心房纵向应变曲线图；图c为术前两腔心切面左心房纵向应变曲线图；图d为术后3个月两腔心切面左心房纵向应变曲线图
1
Cameli M, Mandoli GE, Loiacono F, et al. Left atrial strain: A useful index in atrial fibrillation[J]. Int J Cardiol, 2016, 220: 208-213.
2
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. 经冷冻球囊导管消融心房颤动中国专家共识[J]. 中国心脏起搏与心电生理杂志, 2020, 34(2): 95-109.
3
He B, Jiang LS, Hao ZY, et al. Combination of ablation and left atrial appendage closure as "One-stop" procedure in the treatment of atrial fibrillation: Current status and future perspective[J]. Pacing Clin Electrophysiol, 2021, 44(7): 1259-1266.
4
中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国左心耳封堵预防心房颤动卒中专家共识(2019)[J]. 中华心血管病杂志, 2019, 47(12): 937-955.
5
Cameli M, Mandoli GE, Loiacono F, et al. Left atrial strain: a new parameter for assessment of left ventricular filling pressure[J]. Heart Fail Rev, 2016, 21(1): 65-76.
6
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J]. Eur Heart J, 2016, 37(38): 2893-2962.
7
胡佳, 董立, 郭应强, 等. 心外膜脂肪厚度预测瓣膜置换同期双极射频消融术后房颤复发的价值[J]. 中华胸心血管外科杂志, 2015, 31(4): 193-197.
8
Melillo E, Palmiero G, Ferro A, et al. Diagnosis and management of left atrium appendage thrombosis in atrial fibrillation patients undergoing cardioversion[J]. Medicina (Kaunas), 2019, 55(9): 511.
9
Zhang Y, Sun H, Li M, et al. Impact of stand-alone minimally invasive radiofrequency ablation with left atrial appendectomy on left atrial function assessed by echocardiography[J]. Quant Imaging Med Surg, 2020,10(5): 970-978.
10
Xiong B, Li D, Wang J, et al. The effect of catheter ablation on left atrial size and function for patients with atrial fibrillation: an updated meta-analysis[J]. PLoS One, 2015, 10(7): e0129274.
11
于志琴, 李天亮, 张晓丽, 等. 二维斑点追踪成像技术评价阵发性房颤患者射频消融术前后左心房功能[J]. 中国医学影像技术, 2019, 35(7): 1008-1012.
12
Giannopoulos G, Kossyvakis C, Vrachatis D, et al. Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo-LAEF study) [J]. J Cardiovasc Electrophysiol, 2019, 30(7): 991-998.
13
汪婧, 江峰, 刘表虎, 等. 实时三维超声与斑点追踪技术评价房颤患者射频消融术前后左房结构及功能重构的临床价值[J]. 中国超声医学杂志, 2017, 33(2): 118-121.
14
Li YG, Gong CQ, Zhao MZ, et al. Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure[J]. J Cardiovasc Electrophysiol, 2019, 30(10): 1868-1876.
15
Phan QT, Shin SY, Cho IS, et al. Impact of left atrial appendage closure on cardiac functional and structural remodeling: A difference-in-difference analysis of propensity score matched samples[J]. Cardiol J, 2019, 26(5): 519-528.
16
Moreno-Ruiz LA, Madrid-Miller A, Martínez-Flores JE, et al. Left atrial longitudinal strain by speckle tracking as independent predictor of recurrence after electrical cardioversion in persistent and long standing persistent non-valvular atrial fibrillation[J]. Int J Cardiovasc Imaging, 2019, 35(9): 1587-1596.
17
Mochizuki A, Yuda S, Oi Y, et al. Assessment of left atrial deformation and synchrony by three-dimensional speckle-tracking echocardiography: comparative studies in healthy subjects and patients with atrial fibrillation[J]. J Am Soc Echocardiogr, 2013, 26(2): 165-174.
18
马新欣. 二维斑点追踪成像技术对房颤消融术后远期复发的预测价值[D].上海:上海交通大学, 2017.
19
Loghin C, Karimzadehnajar K, Ekeruo IA, et al. Outcome of pulmonary vein isolation ablation for paroxysmal atrial fibrillation: predictive role of left atrial mechanical dyssynchrony by speckle tracking echocardiography[J]. J Interv Card Electrophysiol, 2014, 39(1): 7-15.
20
Dell'Era G, Rondano E, Franchi E, et al. Atrial asynchrony and function before and after electrical cardioversion for persistent atrial fibrillation[J]. Eur J Echocardiogr, 2010, 11(7): 577-583.
21
邢雪柯, 朱凯, 许玲, 等. 应变及应变率评价心房颤动中左房功能新进展[J]. 心血管病学进展, 2018, 39(5): 784-788.
22
Du X, Chu H, Ye P, et al. Combination of left atrial appendage closure and catheter ablation in a single procedure for patients with atrial fibrillation: Multicenter experience[J]. J Formos Med Assoc, 2019, 118(5): 891-897.
23
Fassini G, Gasperetti A, Italiano G, et al. Cryoballoon pulmonary vein ablation and left atrial appendage closure combined procedure: A long-term follow-up analysis[J]. Heart Rhythm, 2019, 16(9): 1320-1326.
[1] 何金梅, 尹立雪, 谭静, 张文军, 王锐, 任梅, 廖明娇. 超声心肌做功技术对2型糖尿病患者潜在左心室心肌收缩功能损伤的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1029-1035.
[2] 薛艳玲, 马小静, 谢姝瑞, 何俊, 夏娟, 何亚峰. 左心声学造影在急性心肌梗死合并室间隔穿孔中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1036-1039.
[3] 武玺宁, 欧阳云淑, 张一休, 孟华, 徐钟慧, 张培培, 吕珂. 胎儿心脏超声检查在抗SSA/Ro-SSB/La抗体阳性妊娠管理中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1056-1060.
[4] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1061-1067.
[5] 张宝富, 俞劲, 叶菁菁, 俞建根, 马晓辉, 刘喜旺. 先天性原发隔异位型肺静脉异位引流的超声心动图诊断[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1074-1080.
[6] 赵红娟, 赵博文, 潘美, 纪园园, 彭晓慧, 陈冉. 应用多普勒超声定量分析正常中晚孕期胎儿左心室收缩舒张时间指数[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 951-958.
[7] 刘丹妮, 敖梦, 冉海涛, 李世玉, 秦芳. 三维超声心动图及二维斑点追踪成像对持续性心房颤动复律后双心房逆向重构的评估[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 827-835.
[8] 张璟璟, 赵博文, 潘美, 彭晓慧, 毛彦恺, 潘陈可, 朱玲艳, 朱琳琳, 蓝秋晔. 胎儿超声心动图测量McGoon指数在评价胎儿肺血管发育中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 860-865.
[9] 徐鹏, 李军, 高巍伦, 王峥, 庞珅, 李春妮, 朱霆. 快速旋转扫查法在胎儿超声心动图检查中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 761-766.
[10] 应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 581-587.
[11] 吴赤球, 韦曙东, 张辉, 严许清, 梅朵卓嘎, 余丹. 驻不同海拔高度高原人员习服后心脏结构和功能变化的超声心动图评估[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 588-593.
[12] 谭芳, 杨娇娇, 沈玉琴, 李炎菲海, 王海蕊, 范思涵, 纪学芹. 胎儿心脏定量分析技术对正常胎儿心脏形态及收缩功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 598-604.
[13] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[14] 吴群, 张鑫, 李培, 王芳韵, 郑淋, 卫海燕, 马宁. 孤立型主动脉缩窄的超声心动图诊断及术后随访研究[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 642-646.
[15] 薛念余, 张盛敏, 吴凌恒, 沙蕾, 童揽月, 沈崔琴, 李朝军, 杜联芳. 研究血清胆红素对2型糖尿病患者心脏结构发生改变前心肌功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1004-1009.
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