斑点追踪成像技术对心房颤动患者左心耳功能及应变的评估

目的应用斑点追踪成像自动分析技术评估心房颤动患者左心耳功能和应变。 方法回顾性纳入2019年12月至2021年2月空军军医大学唐都医院进行经食管超声心动图检查的心房颤动患者50例，以及性别、年龄匹配的窦性心律患者34例。应用斑点追踪成像技术对左心房、左心耳进行自动容积和应变分析，获取经胸超声心动图以及经食管超声心动图45°、135°图像的相应参数。2组患者间左心房、左心耳自动容积及应变相关参数比较采用独立样本t检验，对左心房应变与左心耳应变进行Pearson线性相关分析，并对不同角度的左心耳容积及应变进行配对t检验。 结果同窦性心律组相比，心房颤动组各角度及平均左心耳容积增大，而各角度及平均左心耳排空分数减小（P均＜0.05）。应变分析显示，心房颤动组各角度及平均左心耳应变低于窦性心律组（P均＜0.05）。平均左心耳应变同左心房应变各指标均呈正相关（P均＜0.05），其中同左心房应变储备功能、通道功能、收缩功能的相关系数分别为0.790、0.667、0.780。经食管超声心动图不同角度（45°与135°）测得的左心耳容积及排空分数差异存在统计学意义（P均＜0.05），其中45°测得的左心耳容积较小［窦性心律组：（3.2±1.4）ml vs（5.1±2.8）ml；心房颤动组：（6.4±3.1）ml vs（12.0±6.3）ml］，而排空分数较大［（窦性心律组：（65.8±10.7）% vs（61.2±9.8）%；心房颤动组：（38.3±12.0）% vs（35.2±11.4）%］。心房颤动组两角度（45°与135°）测得的左心耳应变差异存在统计学意义［（7.9±4.1）% vs（9.2±4.5）%，P=0.045］。 结论心房颤动患者左心耳功能及应变明显降低，建议采用斑点追踪成像双平面法对心房颤动患者左心耳功能及应变进行综合评估。

Evaluation of left atrial appendage function and strain in patients with atrial fibrillation by speckle tracking imaging

ObjectiveTo assess the left atrial appendage (LAA) function and strain by speckle tracking auto-analysis technique in patients with atrial fibrillation (AF), and explore the corresponding skills. MethodsFrom December 2019 to February 2021, 50 patients with AF who underwent transesophageal echocardiography and 34 age- and sex-matched patients with sinus rhythm (SR) at Tangdu Hospital, Air Force Medical University were recruited. The volume and strain of the left atrium (LA) and LAA were measured by speckle tracking auto-analysis technique. The transthoracic echocardiographic images and transesophageal echocardiographic images at 45° and 135° were acquired for data analysis. The independent t test was used for the comparison of left atrial and left atrial appendage volume and strain parameters between groups. The relationship between LA strain and LAA strain was analyzed by linear correlation. The LAA volume and strain estimated in different angles were compared by paired t test. ResultsIn comparison with patients with SR, the LAA volumes estimated in different angles and the mean value were significantly larger in patients with AF, while the emptying fraction was reduced in the AF (P＜0.05). By speckle tracking auto-analysis technique, the LAA strain estimated in different angles and the mean value were significantly reduced in patients with AF (P＜0.05). The mean LAA strain was positively correlated with all LA strain parameters (P＜0.05); the correlation coefficients of LAA strain with LA strain reservoir function, conduit function, and contraction function were 0.790, 0.667, and 0.780, respectively. The LAA volume and emptying fraction measured in different angles (45° and 135°) by transesophageal echocardiography were statistically significantly different (P＜0.05). The LAA volume estimated in 45° was smaller [SR: (3.2±1.4) ml vs (5.1±2.8) ml; AF: (6.4±3.1) ml vs (12.0±6.3) ml], but the emptying fraction was larger [SR: (65.8±10.7)% vs (61.2±9.8)%; AF: (38.3±12.0)% vs (35.2±11.4)%]. The LAA strains measured in the two angles were significantly different [(7.9±4.1)% vs (9.2±4.5)%, P=0.045]. ConclusionThe LAA function and strain are obviously reduced in patients with AF. It is suggested that the bi-plane speckle tracking imaging be applied to analyze the LAA function and strain comprehensively.