房颤患者左心耳形态与力学指标改变的超声分析-ultrasonic analysis of changes of left atrial appendage morphology and mechanical parameters in patients with atrial fibrillation.docxVIP

房颤患者左心耳形态与力学指标改变的超声研究研究生：吴治胜导师：穆玉明教授摘要目的：应用斑点追踪成像技术（STI）及经食管实时三维超声成像（RT-3DTEE）评价房颤患者左心耳局部舒缩运动及功能、形态的变化特点。方法：67例行经食管实时三维超声者，分为对照组24例，阵发性房颤组22例，持续性房颤组21例。将左心耳分为基底段（B）、中段(M)、顶部(A)三个部分，测量三组左心耳及基底段、中段、顶部最大、最小体积。根据左心耳及各部的最大、最小体积，计算左心耳及左心耳各部的排空分数，并计算左心耳各部最大、最小体积分别占左心耳最大、最小体积的比例。应用STI测量左心耳基底段、中段、顶部各节段收缩期应变率（SRS）和舒张期应变率(SRD)。结果：阵发性房颤组和持续性房颤组左心耳整体排空分数、基底段排空分数、中段排空分数、顶部排空分数均低于对照组。三组组内左心耳基底段、中段、顶部排空分数间差异无统计学意义。对照组、阵发性房颤组、持续性房颤组间左心耳基底段、中段、顶部体积百分比无明显差异。与对照组比较，阵发性房颤组和持续性房颤组的左心耳基底段、中间段、顶部各段的SRS和SRD均较降低，以持续性房颤组降低更显著。结论:阵发性房颤和持续性房颤均可导致左心耳整体和局部舒缩功能降低，以持续性房颤为甚。阵发性房颤组、持续性房颤组的左心耳基本形态并未改变，体积和收缩功能是整体、弥漫性的改变，不存在局部形态和功能改变。关键词：超声心动描记术，经食管，实时三维，左心耳，斑点跟踪StudyofLeftAtrialAppendageMorphologyandMechanicalIndexChangesinPatientswithAtrialFibrillationbyEchocardiographyPostgraduate:WuZhi-sheng,Supervisor:Prof.MUYu-mingAbstractobjectiveToevaluateleftatrialappendagemovementchangesofsystolicanddiastolic,regionalfunctionandmorphologychangesinpatientswithatrialfibrillationbyspeckletrackingimagingandreal-timethree-dimensionaltransesophagealechocardiography.Methodssixty-sevenpatientsunderwentRT-3DTEEwasdividedinto22controls,22paroxysmalatrialfibrillation,21persistentatrialfibrillation.Leftatrialappendagewasdividedintobasal,middleandapicalsegment.Leftatrialappendageemptyingfractionoftheoverall(LAA-EF),basalemptyingfraction(B-EF),themiddleofemptyingfraction(M-EF)andtheapicaloftheemptyingfraction(A-EF)wasmeasuredbythree-dimensionalvolumemeasurement.Measuremaxandminvolumeofleftatrialappendageandeverysegments,andthencalculateejectionfractionofleftatrialappendageandeverysegmentsandmaxandminvolumefractionofeverysegments.Eachsegmentsystolicstrainrate(SRS)anddiastolicstrainrate(SRD)wasmeasuredbySTI.ResultsParoxysmalatrialfibrillationandpersistentatrialfibrillationgroupLAA-EF,B-EF,M-EF,A-EFwerelowerthanthecontrolgroupandpersistentatrialfibrillationgroupwasthelowestinthethreegroups.Base,middleandtopejectionfractionofleftatrialappendagewasnosignificantdifferenceinthreegroups(Pall0.05).Therewasnosignificantdifferenceinvo