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目的:采用实时三维超声心动图(RT-3DE)和二维斑点追踪成像(2D-STI)评价不同时期心房颤动(房颤)患者的左房结构和功能。方法:分别对24例健康对照组和48例房颤患者(房颤间歇期为AFl组,发作期为AF2组)行超声心动图检查。应用RT-3DE计算左房最大容积指数(LAVImax)、左房最小容积指数(LAVImin)、左房收缩前容积指数(LAVIp)、左房总射血分数(LATEF)、左房扩张指数(LAEI)、左房被动射血分数(LAPEF)和左房主动射血分数(LAAEF);应用2D-STI获取左房壁各节段的应变-时间曲线,测量收缩期、舒张早期和舒张晚期的左房平均峰值应变(mSs、mSe、mSa)、峰值应变率(mSRs、mSRe、mSRa),并计算左房僵硬度(LASt)。结果:与对照组比较,AFl组和AF2组左房内径(LAD)、左房容积指数(LAVI)增大,mSs、mSe、mSRs减低(均P<0.05),且AF2组更明显,mSRe在AF1和对照组间差异无统计学意义。AF1组mSa、mSRa减低(均P<0.01),AF2组mSa、mSRa消失,LASt增高(均P<0.01)。LASt与LAVImax、LAVImin呈正相关,与LATEF、LAEI、mSs、mSRs、mSe、mSRe呈负相关。结论:房颤患者左房容积增大。房颤间歇期左房储存功能及辅泵功能降低;发作期左房辅泵功能消失,储存功能及管道功能降低,左房僵硬度增高。左房僵硬度与LAVImax、LAVImin、左房储存功能、管道功能相关。
Objective: To evaluate left atrial structure and function in patients with atrial fibrillation (AF) at different periods by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D- STI). Methods: Echocardiography was performed on 24 healthy controls and 48 patients with atrial fibrillation (AFl group during the interictal atrial fibrillation and AF2 group during the episode). The LAVImax, LAVImin, LAVIp, LATEF and LAEI were calculated by RT-3DE. The left ventricular mass index (LAPEF) and left atrial spontaneous ejection fraction (LAAEF). The strain-time curve of each segment of left atrial wall was obtained by 2D-STI, and the left atria of systole, early diastole and late diastole were measured. Mean peak strain (mSs, mSe, mSa) and peak strain rate (mSRs, mSRe, mSRa) were calculated and left atrial stiffness (LASt) was calculated. Results: Compared with the control group, left ventricular diameter (LAD) and left atrial volume index (LAVI) increased and mSs, mSe and mSRs decreased in AFl group and AF2 group (all P <0.05) There was no significant difference between AF1 and control group. MSa and mSRa in AF1 group decreased (all P <0.01), mSa and mSRa in AF2 group disappeared and LASt increased (all P <0.01). LASt was positively correlated with LAVImax and LAVImin, but negatively correlated with LATEF, LAEI, mSs, mSRs, mSe and mSRe. Conclusion: Atrial fibrillation patients with left atrial volume increased. Atrial fibrillation intermittent left atrial storage function and auxiliary pump function decreased; episodes of atrial function disappeared left atrial pump, storage function and reduce the function of the pipeline, left atrial stiffness increased. Left atrial stiffness and LAVImax, LAVImin, left atrial storage function, the pipeline function related.