摘要
目的应用经食管三维超声心动图（RT-3DTEE）探讨心房颤动（简称房颤）窦性心律恢复前后房性二尖瓣反流（AMR）与二尖瓣复合体构型及左房功能变化间的关系。方法选取55例行房颤射频消融术复律并保持窦性心律1年且复律前存在中度以上AMR的患者，术前及术后1年随访时以RT-3DTEE测量二尖瓣对合径（IC）、前后径（AP）、瓣环高度（AH）、二尖瓣面积（MVA）、帆状高度（TH）及容积（TV），并计算出瓣环曲度指数（ASI）、MVA变化分数（MVA-FAC）和对合指数（CPI），同时记录左房最大容积（LAV）、左房容积指数（LAVI）、左房面积（LAA）、左房前后径（LAD）及二尖瓣口有效反流面积（EROA）。结果射频消融术后1年，恢复窦律患者AMR程度较房颤复发患者明显减轻FEROA：（0．27±0．03）cm2对（0．21±0．04）cm2，P〈0．001]，左房面积及容积参数较射频术前有所减低[LAA：（22．70±3．34）cm2对（18．80±3．45）cm2，LAV：（52．77±5．41）cm3对（45．22±6．49）cm2，LAVI：26．30±3．12对22．98±3．03，均P〈0．001]。多元线性分析结果显示CPI（p=-0．549，P〈0．05），MVA—FAC（B=-0．309，P〈0．05）和LAVI（B=1．712，P〈0．05）与EROA的变化独立相关。结论房颤复律后窦性心律的维持可减轻左房容量负荷以增加二尖瓣对合能力，对减少房性反流有促进作用。RT-3D TEE可对此类患者二尖瓣／环三维构型改变进行动态观察。
Objective To determine whether changes in mitral annular spatial conformation and left atrial （LA） volume are closely related to atrial functional mitral regurgitation （AMR） in patients with atrial fibrillation and before or after the sinus rhythm recovery using real-time three-dimensional transesophageal echocardiography （RT-3D TEE）. Methods Fifty-five patients with AMR of at least moderate severity who completed one-year of clinical follow-up after ablation were included in this study. Before ablation and after being followed for one year, intercommissural （IC） and anteroposterior （AP） diameter, annular height （AH） and area （MVA）, tenting height （TH） and volume （TV）, annular spherical index （ASI）, fractional area change of MVA （MVA-FAC）, and coaptation index （CPI） were defined and measured by mitral valve quantification software （MVQ）. Left atrial volume（LAV）, left atrial volume index（LAVI）, left atrial area （LAA）, left atrial diameter （LAD） and effective regurgitant orifice area （EROA） were also recorded. Results After one year of follow-up, AMR decreased significantly in patients with sinus rhythm [EROA： （0.27±0.03）cm2 vs （0.21 ±0.04）cm2, P 〈0.001]. LAA, LAV and LAVI were improved in patients with sinus rhythm [LAA： （22.70 ± 3.34）cm2 vs （18.80 ± 3.45 ）cm2 , LAV： （52.77 ± 5.41 ）cm2 vs （45.22 ± 6.49）cm2,LAVI：26.30±3.12 vs 22. 98 ±3 . 03 , all P G0.001]. CPI（β= -0.549, P 〈0.05）,MVA-FAC （β= -0. 309, P 〈0.05） and LAV（β= 1. 712, P G0.05）, MVA-FAC） were independently associated with the reduction in EROA. Conclusions AMR can he decreased through the sinus rhythm recovery and maintenance after ablation, which are caused by improvement of left atrial volume load and leaflets coaptation capability. RT 3D TEE may dynamically assess the changes in leaflets/annular configuration during the AMR follow-up.
出处
《中华超声影像学杂志》
CSCD
北大核心
2017年第10期839-844,共6页
Chinese Journal of Ultrasonography
基金
乌鲁木齐市科技项目（Y141010030）
关键词
超声心动描记术
经食管
实时三维
心房颤动
心房功能
左
Echocardiograpby, transesophageal, real time three-dimension
Atrial fibrillation
Atrial function, left
