TEE结合2D-STI技术探讨房颤患者左心耳功能与射频消融术后房颤复发的关系

目的:应用经食道超声心动图(TEE)探讨房颤(AF)患者左心耳(LAA)功能变化与射频消融术后AF复发的关系。方法:选取2017年2月-2019年4月沈阳医学院附属第二医院心血管内科收治的AF患者68例,所有患者分别于射频消融术前24~48 h、术后24~48 h及3月行TEE检查,术后3月再根据患者复律的情况,分为窦性心律组(A组)及AF复发组(B组),测量患者LAA充盈及排空速率(LAA-Fv、LAA-Ev),LAA最大开口内径(LAA-D),LAA最大深度(LAA-L),LAA射血分数(LAA-EF)及LAA收缩期应变率(LAA-Ssr)等。比较术前、术后各指标的差异并分析其与AF复发的关系。结果:术后24~48 h与术前相比,患者LAA-Fv、LAA-Ev、LAA-EF、LAA-Ssr、LAA-L及LAA-D均未见明显变化(P>0.05);术后3月:A组(51例)与术前相比,LAA-Ev、LAA-Fv、LAA-EF,LAA-Ssr均明显增高,LAA-D明显缩小,差异有统计学意义(P<0.05);B组(17例)与术前相比,LAA-Ev、LAA-Fv、LAA-EF,LAA-Ssr明显降低,LAA-D明显增大,差异有统计学意义(P<0.05),B组另有4例患者LAA内出现血流自发显影(SEC)。二元Logistic回归分析显示LAA-Ev、LAA-Fv、LAA-EF及LAA-Ssr均是AF复发的预测因子,其对应的ROC曲线下面积分别为0.864、0.817、0.803及0.887。结论:LAA-Ev、LAA-Fv、LAA-EF及LAA-Ssr均可作为射频消融术后AF复发的预测因子,且LAA-Ssr的预测效能更优。

The relationships between left atrial appendage function and the recurrence of atrial fibrillation in patients after radiofrequency ablation by TEE and 2D-STI technique

Objective: Transesophageal echocardiography(TEE) is used to investigate the relationships between left atrial appendage(LAA) function and the recurrence of atrial fibrillation(AF) in patients after radiofrequency ablation. Methods: Sixtyeight AF patients were selected. All patients were examined by TEE, 24~48 h before radiofrequency ablation, 24 ~48 h after radiofrequency ablation, and 3 months after radiofrequency ablation. According to the recurrence of AF, patients were divided into sinus rhythm group(group A) and AF recurrence group(group B). Having measured the LAA flow filling velocity and emptying velocity(LAA-Fv, LAA-Ev), LAA maximum diameter(LAA-D), LAA maximum length(LAA-L), LAA ejection fraction(LAAEF) and LAA systolic strain rate(LAA-Ssr). Compared the differences in each group and analyzed the relationships between the function of LAA and the recurrence of AF after radiofrequency ablation by logistic regression. Results: Compared with preoperation: There were no significant changes in LAA-Fv, LAA-Ev, LAA-EF, LAA-Ssr, LAA-L and LAA-D 24~48 h after operation(all P>0.05);3 months later, LAA-Ev, LAA-Fv, LAA-EF, LAA-Ssr were significantly higher and LAA-D was significantly lower in group A(51 patients)(all P<0.05);LAA-Ev, LAA-Fv, LAA-EF, LAA-Ssr and LAA-D were significantly lower and LAA-D was significantly larger in group B(17 patients)(all P<0.05), and spontaneous echo contrast(SEC) were found in 4 patients’ s LAA in group B. Logistic regression analysis showed that LAA-Ev, LAA-Fv, LAA-EF and LAA-Ssr were predictors of AF recurrence. The area under the ROC curve of LAA-Ev, LAA-Fv, LAA-EF and LAA-Ssr were 0.864, 0.817, 0.803 and0.887. Conclusion: LAA-Ev, LAA-Fv, LAA-EF and LAA-Ssr can be used as predictors of AF recurrence to evaluate the prognosis of patients after radiofrequency ablation, and the predictive effect of LAA-Ssr is better.