STI技术评价阵发性房颤病人经导管射频消融术前及术后左心房功能和结构的变化

    Evaluation of left atrial function and structure changes in patients with paroxysmal atrial fibrillation before and after transcatheter radiofrequency ablation using STI technology

    • 摘要: 目的: 观察应用二维斑点追踪成像(two-dimensional speckle tracking imaging,STI)测量阵发性心房颤动(atrial fibrillation,AF)病人经导管射频消融术前和术后左心房结构和功能的改变,以评估射频消融术对阵发性AF的临床疗效。方法: 选取因阵发性AF行导管射频消融术的33例病人,按照术后是否恢复窦性心律分为窦性心律组25例和复发组8例。并在术前、术后3 d、术后3个月行心脏彩超检查,测量左心房大小(LAD)、左心房前后径(LAAPD)、左心房上下径(LAUDD)、左心房左右径(LALRD)、舒张末期左心房容积(EDLAV)、收缩末期左心房容积(ESLAV)、左心房射血分数(LAEF)。STI技术测量左心房整体纵向应变(LAGLS)、整体纵向应变率(LAGLSR)及左心房左壁、顶部和右壁应变和应变率。结果: 术后3 d,2组病人所有左心房结构和功能指标与术前相比差异均无统计学意义(P>0.05)。术后3个月,窦性心律组病人LAD、LAAPD、LALRD、LAUDD、EDLAV、ESLAV与术前及术后3 d相比均下降(P<0.05),LAEF与术前及术后3 d 相比均升高(P<0.05),LAGLS、LAGLSR及左心房左壁、顶部、右壁应变及应变率与术前及术后3 d相比均增加(P<0.05);复发组病人LAUDD、LAD、EDLAV、ESLAV与手术前及术后3 d相比较均升高(P<0.05),LAEF与术前及术后3 d相比均降低(P<0.05),LAAPD、LALRD与术后3 d相比差异均无统计学意义(P>0.05),LAGLS及左心房左壁、顶部、右壁应变与术前及术后3 d相比均减少(P<0.05),LAGLSR及左心房左壁、顶部、右壁应变率与术前及术后3 d相比较有轻微减少,但差异无统计学意义(P>0.05)。术后3 d及术后3个月,窦性心律组病人LAD、LAAPD、LALRD、LAUDD、EDLAV、ESLAV均低于复发组病人(P<0.05~P<0.01),而LAEF明显高于复发组(P<0.01)。术后3个月,窦性心律组病人LAGLS、LAGLSR、左心房左壁、顶部、右壁应变及应变率均明显高于复发组(P<0.01)。结论: 阵发性AF病人经射频消融术恢复窦性心律后左心房功能及结构会逐步改善,而复发的病人左心房功能及结构均无显著改善,甚至会进一步加重。

       

      Abstract: Objective: To observe the changes of structure and function of left atrium before and after transcatheter radiofrequency ablation by two-dimensional speckle tracking imaging (STI) technology in paroxysmal atrial fibrillation(AF)patients,so as to evaluate the clinical efficacy of radiofrequency ablation in paroxysmal AF. Methods: A total of 33 patients undergoing transcatheter radiofrequency ablation for paroxysmal AF were selected and divided into the sinus rhythm group (n=25) and recurrence group (n=8) according to whether sinus rhythm was restored after surgery.Cardiac color-ultrasound examination was performed to measure left atrial diameter (LAD),left atrial anteroposterior diameter (LAAPD),left atrial upper and lower diameter (LAUDD),left atrial left and right diameter (LALRD),end diastolic left atrial volume (EDLAV),end systolic left atrial volume (ESLAV),and left atrial ejection fraction (LAEF) before surgery,3 days after surgery,and 3 months after surgery.STI was applied to measure the left atrium global longitudinal strain(LAGLS) and left atrium global longitudinal strain(LAGLSR),as well as the strains and strain rates of left wall,roof and right wall of left atrium. Results: At 3 days after surgery,there was no statistically significant difference in all left atrium structure and function indicators of patients between the two groups compared with before surgery (P>0.05).At 3 months after surgery,in the sinus rhythm group,LAD,LAAPD,LALRD,LAUDD,EDLAV,ESLAV decreased compared with before surgery and 3 days after surgery (P<0.05),LAEF increased compared with before surgery and 3 days after surgery (P<0.05),LAGLS,LAGLSR,and strains and strain rates of left wall,roof and right wall of left atrium increased compared with before surgery and 3 days after surgery (P<0.05).At 3 months after surgery,in the recurrence group,the LAUDD,LAD,EDLAV,ESLAV increased compared with before surgery and 3 days after surgery(P<0.05),LAEF decreased compared with before surgery and 3 days after surgery (P<0.05),while there was no statistically significant difference in LAAPD,LALRD compared with 3 days after surgery (P>0.05);LAGLS and strains of left wall,roof and right wall of left atrium decreased compared with before surgery and 3 days after surgery (P<0.05),LAGLSR and strain rates of left wall,roof and right wall of left atrium slightly decreased compared with before surgery and 3 days after surgery,but the difference of which was not statistically significant (P>0.05).At 3 days and 3 months after surgery,the LAD,LAAPD,LALRD,LAUDD,EDLAV,and ESLAV of patients in the sinus rhythm group were lower than those in the recurrence group (P<0.05 to P<0.01),while LAEF was significantly higher than that in the recurrence group (P<0.01).At 3 months after surgery,LAGLS,LAGLSR,strains and strain rates of left wall,roof and right wall of left atrium of patients in the sinus rhythm group were significantly higher than those in the recurrence group(P<0.01). Conclusions: The left atrium function and structure of patients with paroxysmal AF gradually improve after the restoration of sinus rhythm after radiofrequency ablation,while the left atrium function and structure of patients with recurrence do not significantly improve,and may even get worse.

       

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