经食管实时三维超声心动图及经胸超声心动图评价房颤患者左心耳功能的应用研究

Application of transesophageal real time three dimensional echocardiography and transthoracic echocardiography in evaluating left atrial ear function in patients with atrial fibrillation

摘要:

目的 采用经食管实时三维超声心动图（3D TEE）及经胸超声心动图（TTE），评估心房颤动（以下简称房颤）患者左心耳的功能，并探索其临床应用价值。方法 回顾性分析2021年1月—2024年7月在九江学院附属医院超声科接受常规TTE及3D TEE检查的150例患者的临床资料，根据心律异常的类型分为房颤组（93例）及窦性心律组（57例）。评估患者左心耳的形态、功能；采用TTE测量左心室射血分数（LVEF）、左心房容积（LAV）、早期舒张跨二尖瓣速度与早期二尖瓣环舒张速度比值（E/A）；采用3D-TEE测量二维射血分数（EFA-2D）、三维射血分数（EFA-3D）、三维心室射血分数（EFV-3D）、峰值血流排空速度（PEV）、左心耳直径（LAA-D）、左心耳角度（LAA-A）、三维左心耳排空分数（LAAEF-3D）。采用Pearson法分析各项检测指标与左心耳PEV的相关性。结果 房颤组左心耳分叶数为单叶、二叶、三叶和四叶患者分别为15、46、25和7例，窦性心律组分别为3、27、16和11例；房颤组单叶构成高于窦性心律组（P <0.05）；房颤组EFA-2D、EFA-3D、EFV-3D和PEV均低于窦性心律组（P <0.05）；房颤组LVEF、E/A比、LAA-D、LAA-A、LAAEF-3D均低于窦性心律组，LAV高于窦性心律组（P <0.05）；PEV与EFA-2D（r =0.186，P =0.022）、EFA-3D（r =0.213，P =0.009）、EFV-3D（r =0.189，P =0.020）、LVEF（r = 0.196，P =0.016）、E/A（r =0.184，P =0.024）、LAA-D（r =0.191，P =0.019）、LAA-A（r =0.257，P =0.002）、LAAEF-3D（r =0.267，P =0.001）均呈正相关；PEV与LAV（r =-0.223，P =0.006）呈负相关。结论 房颤显著影响了左心耳的形态和功能，与窦性心律相比，房颤患者的左心耳形态更为复杂，功能显著受损。临床使用3D TEE对房颤患者的左心耳进行详细评估非常重要，能更好地理解房颤对心脏结构和功能的具体影响，并为患者提供更精确的治疗策略。

Abstract:

Objective To assesses the function of the left atrial appendage (LAA) in patients with atrial fibrillation (AF) using real-time transesophageal three-dimensional echocardiography (RT-3D TEE) and transthoracic echocardiography (TTE), aiming to explore its clinical relevance.Method The study included 150 AF patients treated at the Affiliated Hospital of Jiujiang University from January 2021 to July 2024. Patients were categorized based on their heart rhythm into an atrial fibrillation group (93 cases) and a sinus rhythm group (57 cases). All participants underwent RT-3D TEE and TTE to evaluate the morphology and function of the LAA, along with other cardiac ultrasound parameters. The study also analyzed the correlation between various ultrasonographic indicators and the peak flow velocity of the LAA using Pearson's correlation coefficient.Results The number of lobes in the left atrial appendage (LAA) among patients with atrial fibrillation (AF) and those with sinus rhythm were as follows: 15 cases, 46 cases, 25 cases, and 7 cases for one-lobe, two-lobe, three-lobe, and four-lobe configurations, respectively, in the AF group; and 3 cases, 27 cases, 16 cases, and 11 cases, respectively, in the sinus rhythm group. The proportion of single-lobed LAA was significantly higher in the AF group than in the sinus rhythm group (P < 0.05). In comparing LAA emptying fraction and peak velocity between the two groups, the levels of EFA-2D, EFA-3D, EFV-3D, and PEV were all significantly lower in the AF group than in the sinus rhythm group (P < 0.05). Additionally, in the AF group, the levels of LVEF, E/A ratio, LAA-D, LAA-A, and LAAEF-3D were lower, while LAV was higher, compared to the sinus rhythm group (P < 0.05). PEV was positively correlated with EFA-2D (r = 0.186, P = 0.022), EFA-3D (r = 0.213, P = 0.009), EFV-3D (r = 0.189, P = 0.020), LVEF (r = 0.196, P = 0.016), E/A ratio (r = 0.184, P = 0.024), LAA-D% (r = 0.191, P = 0.019), LAA-A% (r = 0.257, P = 0.002), and LAAEF-3D (r = 0.267, P = 0.001). PEV was negatively correlated with LAV (r = -0.223, P = 0.006).Conclusion Atrial fibrillation profoundly impacts the morphology and functionality of the LAA. Compared to sinus rhythm, AF patients exhibit more complex LAA morphologies and significantly reduced functionality. Utilizing RT-3D TEE for detailed evaluation of the LAA in AF patients is crucial for understanding the specific effects of AF on cardiac structure and function, thereby aiding in the formulation of more precise treatment strategies.