三维斑点追踪成像在评价房颤患者射频消融术前后左心室功能中的应用

Application of Three-Dimensional Speckle Tracking Imaging in Evaluating Left Ventricular Function in Patients with Atrial Fibrillation before and after Radiofrequency Ablation

摘要: 目的：应用三维斑点追踪成像(3D-STI)评价心房颤动(房颤，AF)患者经导管射频消融术(RFCA)前后左心室收缩功能的变化。方法：选取进行RFCA治疗成功的31例阵发性AF患者(PAF组)及32例持续性AF患者(CAF组)，另选取30例健康志愿者(对照组)，三组均于术前及术后3个月完成超声心电图检查，并对采集图像进行三维应变分析，得到左心室心肌整体纵向、径向、圆周应变(GLS, GRS, GCS)。比较三组间各参数差异及PAF组和CAF组术前、术后差异。结果：与对照组比较，术前PAF组e'、E/e'增加，GLS减低，CAF组E、E/e'增加，LVEF、GLS、GCS减低，差异有统计学意义(P < 0.05)。与术前相比，术后PAF组e'、GLS增加(P < 0.05)，CAF组E/e'减低，e'、LVEF、GLS、GCS增加(P < 0.05)。结论：较健康志愿者，AF患者的左心室收缩功能已受损；RFCA能有效逆转PAF和CAF患者的左心室重构，改善患者左心室收缩功能；3D-STI能早期有效评价左心室功能的微小变化。

Abstract: Objective: To evaluate the changes in left ventricular systolic function before and after transcathe-ter radiofrequency ablation (RFCA) in patients with atrial fibrillation (AF) by applying three- di-mensional speckle tracking imaging (3D-STI). Methods: Thirty-one patients with paroxysmal AF (PAF group) and 32 patients with persistent AF (CAF group) who underwent RFCA successfully, and 30 healthy volunteers (control group) were selected. All three groups completed echocardiography before and 3 months after the procedure, and 3D strain analysis was performed on the acquired images to obtain the overall longitudinal, radial, and circumferential strains of the left ventricular myocardium (GLS, GRS, and GCS). The differences in the parameters between the three groups and the preoperative and postoperative differences between the PAF and CAF groups were compared. Results: Compared with the control group, e' and E/e' increased and GLS decreased in the PAF group before surgery, while E and E/e' increased and LVEF, GLS and GCS decreased in the CAF group, with statistically significant differences (P < 0.05). Compared to the preoperative period, e', GLS in-creased in the PAF group (P < 0.05) and E/e' decreased and e', LVEF, GLS, GCS increased in the CAF group (P < 0.05). Conclusion: In healthy volunteers, LV systolic function was already impaired in AF patients; RFCA was effective in reversing LV remodeling and improving LV systolic function in PAF and CAF patients; 3D-STI was effective in early evaluation of small changes in LV function.