2D-STI在评价冠心病阵发性房颤患者RFCA术后左心功能中的应用

doi:10.7517/issn.1674-0475.220306

摘要/Abstract

摘要： 本研究探讨二维斑点追踪成像技术（2D-STI）在冠心病阵发性房颤患者经导管射频消融术（RFCA）治疗后的左心功能评估中的价值。选取实施RFCA治疗的78例冠心病合并阵发性房颤患者作为病例组、同期接受2D-STI检查的80例非房颤冠心病患者作为对照组，病例组均接受RFCA治疗，采用二维超声及2D-STI测定两组研究对象的左心功能参数及心肌力学参数。病例组患者的左心室舒张末期内径（LVDd）、二尖瓣反流面积（MRA）、左房舒张末期面积（LAA）、二尖瓣口舒张早期峰值血流速度/二尖瓣环侧壁及间隔壁舒张早期峰值运动速度（E/E'）测定值均高于对照组（P<0.05）；病例组患者的左室射血分数（LVEF）测定值低于对照组（P<0.05）。病例组患者的收缩期左心房峰值应变（SLAs）及应变率（SRLAs）、舒张早期左心房峰值应变（SLAed）及应变率（SRLAed）、心房收缩期左心房峰值应变（SLAac）及应变率（SRLAac）测定值均低于对照组（P<0.05）。经过RFCA治疗后3个月再次复查，病例组患者的LVDd、MRA、LAA、E/E'测定值均较治疗前显著降低，LVEF值较治疗前显著升高（P<0.05）；病例组患者的SLAs、SRLAs、SLAed、SRLAed、SLAac、SRLAac测定值均较术前显著提高（P<0.05）。2D-STI能很好地评估冠心病阵发性房颤患者经RFCA治疗前后左心功能，RFCA治疗冠心病阵发性房颤效果显著。

关键词: 二维斑点追踪成像技术, 冠心病, 阵发性房颤, 经导管射频消融术, 左心功能

Abstract: This study investigated the value of two-dimensional speckle tracking imaging (2D-STI) in the evaluation of left ventricular function in patients with coronary heart disease with paroxysmal atrial fibrillation after radiofrequency catheter ablation (RFCA). A total of 78 patients with coronary heart disease and paroxysmal atrial fibrillation who underwent RFCA treatment were selected as the case group, and 80 patients with non-atrial fibrillation received 2D-STI examination during the same period. Coronary heart disease patients served as the control group, and the case group received RFCA treatment. Two-dimensional ultrasound and 2D-STI were used to measure the left ventricular function parameters and myocardial mechanical parameters of the two groups of subjects. Left ventricular end-diastolic diameter (LVDd), mitral valve regurgitation area (MRA), left atrial end-diastolic area (LAA), forward flow velocity in the early diastole of the mitral valve/early diastolic mitral valve annulus,and the measured values of wind velocity (E/E') in the case group were higher than those in the control group (P<0.05). The measured value of left ventricular ejection fraction (LVEF) in the case group was lower than that in the control group (P<0.05). The systolic left atrial peak strains (SLAs) and strain rates (SRLAs), the early diastolic left atrial peak strains (SLAed) and strain rates (SRLAed), and the atrial systolic left atrial peak strains (SLAac) and strain rates (the measured values of SRLAac) were lower than those of the control group (P<0.05). Re-examination 3 months after RFCA treatment, the measured values of LVDd, MRA, LAA, and E/E' in the case group were significantly lower than those before treatment, and the LVEF value was significantly higher than those before treatment (P<0.05). The measured values of SLAs, SRLAs, SLAed, SRLAed, SLAac, and SRLAac in the case group were significantly higher than those before operation (P<0.05). 2D-STI can well evaluate the left ventricular function of patients with paroxysmal atrial fibrillation of coronary heart disease before and after RFCA treatment, and RFCA has a significant effect on the treatment of paroxysmal atrial fibrillation of coronary heart disease.

Key words: two-dimensional speckle tracking imaging, coronary heart disease, paroxysmal atrial fibrillation, radiofrequency catheter ablation, left ventricular function

农俊, 许键, 农华平, 蓝雪丹. 2D-STI在评价冠心病阵发性房颤患者RFCA术后左心功能中的应用[J]. 影像科学与光化学, 2022, 40(4): 873-877.

NONG Jun, XU Jian, NONG Huaping, LAN Xuedan. Application of 2D-STI in Evaluating Left Ventricular Function in Patients with Coronary Heart Disease and Paroxysmal Atrial Fibrillation after RFCA[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(4): 873-877.

参考文献

[1] 滕花, 冉海涛, 任建丽. 三维斑点追踪成像技术评价左心房结构与功能研究进展[J]. 中国介入影像与治疗学, 2019,16(6):368-371.
[2] 陈晓沛, 姜志荣, 王小凡, 等. 实时三维超声联合二维斑点追踪成像评价原发性高血压患者左心房功能[J]. 中国医学影像技术, 2019,35(6):843-847.
[3] 颜红兵, 马长生, 霍勇. 美国冠心病诊断与治疗指南[M]. 2版. 北京:中国环境科学出版社, 2006:115.
[4] 王吉云. 从《2016年欧洲房颤管理指南》看心房颤动脑卒中预防中的临床问题[J]. 中国全科医学, 2017,20(2):123-126.
[5] 胡志成, 蒋超, 刘尚雨, 等. 中国心房颤动介入治疗现况与质量分析[J]. 中华心血管病杂志, 2021,49(3):224-228.
[6] Kosiuk J, Langenhan K, Stegmann C, et al. Effect of remote ischemic preconditioning on electrophysiological parameters in nonvalvular paroxysmal atrial fibrillation:The RIPPAF Randomized Clinical Trial-ScienceDirect[J]. Heart Rhythm, 2020,17(1):3-9.
[7] Mazurek M, Halperin J L, Huisman M V, et al. Antithrombotic treatment for newly diagnosed atrial fibrillation in relation to patient age:The GLORIA-AF registry programme[J]. EP Europace, 2019,22(1):47-57.
[8] Buist T J, Adiyaman A, Beukema R J, et al. Quality of life after catheter and minimally invasive surgical ablation of paroxysmal and early persistent atrial fibrillation:Results from the SCALAF trial[J]. Clinical Research in Cardiology:Offical Journal of the German Cardiac Society, 2020,109(2):215-224.
[9] Kuniss M, Akkaya E, Berkowitsch A, et al. Left atrial roof ablation in patients with persistent atrial fibrillation using the second-generation cryoballoon:Benefit or wasted time?[J]. Clinical Research in Cardiology, 2020,109(6):714-724.
[10] Halima M B, Boudiche S, Sammoud K, et al. Severe obstructive sleep apnea in Tunisian population with atrial fibrillation:Prevalence and predictive factors[J]. Archives of Cardiovascular Diseases Supplements, 2020,12(1):123-124.
[11] Chauhan V S, Verma A, Nayyar S, et al. Focal source and trigger mapping in atrial fibrillation:Randomized controlled trial evaluating a novel adjunctive ablation strategy[J]. Heart Rhythm, 2020,17(5):683-691.
[12] 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.
[13] 文鹤龄, 陈宇, 梁中书. 三维斑点追踪成像对阵发性房颤患者射频消融术前后左心室收缩功能的评价[J]. 实用医学杂志, 2019,35(3):467-470.
[14] 贾晓宇, 王志斌, 王吴刚, 等. 三维斑点追踪成像评价高血压合并阵发性房颤患者左心房功能[J]. 中国超声医学杂志, 2020,36(1):40-42.
[15] 王臻, 秦文娟, 翟子敬, 等. 二维斑点追踪成像评价红景天苷对脓毒症大鼠心功能的保护作用[J]. 中国医学影像技术, 2021,37(7):961-966.