二维斑点追踪技术及实时三维超声心动图评估心房功能性二尖瓣反流患者导管消融疗效及其影响因素分析
Evaluation of the efficacy of catheter ablation in patients with atrial functional mitral regurgitation by two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography and the influencing factors analysis
李安妮 1高小瞻 2周畅1
作者信息
- 1. 443000 湖北省宜昌市,三峡大学第一临床医学院超声科
- 2. 三峡大学第二临床医学院超声科
- 折叠
摘要
目的 应用二维斑点追踪技术(2D-STI)及实时三维超声心动图(RT-3DE)评估心房功能性二尖瓣反流(AFMR)患者导管消融术后疗效,分析术后二尖瓣反流改善的影响因素.方法 选取于我院首次接受导管消融治疗的AFMR患者47例,术后6个月复查超声心动图,根据AFMR是否改善分为改善组(22例)和未改善组(25例).应用常规超声心动图测量左房前后径(LAD)、二尖瓣环前后径(MAD)、左室收缩末期内径、左室舒张末期内径、左室射血分数等;2D-STI测量左房存储期纵向应变(LASr)、管道期纵向应变(LAScd)、辅泵期纵向应变(LASct);RT-3DE测量左房最大容积、左房最小容积并经体表面积标化得到相应的容积指数(LAVImax、LAVImin),计算左房射血分数(LAEF)及左房扩张指数(LAEI),比较两组术前、术后6个月上述参数的差异.采用二元Logistic回归分析AFMR患者导管消融术后二尖瓣反流改善的预测因素;绘制受试者工作特征(ROC)曲线分析各因素预测AFMR患者导管消融术后疗效的诊断价值.结果 与导管消融术前比较,改善组和非改善组术后6个月LAD、MAD、LAVImax、LAVImin均减小,LASr、LAScd、LASct、LAEF及LAEI均增大,差异均有统计学意义(均P<0.05);改善组术后6个月LAD、LAVImax、LAVImin均小于未改善组,LASr、LAScd均大于未改善组,差异均有统计学意义(均P<0.05).二元Logistic回归分析显示,MAD、LASr均为AFMR患者导管消融术后二尖瓣反流改善的独立预测因素(OR=5.552、0.733,均P=0.031).ROC曲线分析显示,MAD、LASr预测AFMR患者二尖瓣反流改善的曲线下面积分别为0.775、0.735,截断值分别为 3.35 cm、18.05%.结论 2D-STI及RT-3DE可以准确评估AFMR患者导管消融术后疗效;MAD、LASr均为术后二尖瓣反流改善的独立预测因素.
Abstract
Objective To evaluate the efficacy of catheter ablation in patients with atrial functional mitral regurgitation(AFMR)by two-dimensional speckle tracking imaging(2D-STI)and real-time three-dimensional echocardiography(RT-3DE),and to explore the influencing factors for improvement of mitral regurgitation after catheter ablation.Methods Forty-seven patients with AFMR who underwent catheter ablation for the first time in our hospital were selected.Six months after the procedure,echocardiography was performed to evaluate mitral regurgitation improvement,and patients were divided into improvement group(n=22)and non-improvement group(n=25)according to the improvement status.The left atrial diameter(LAD),mitral annular diameter(MAD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were measured by conventional echocardiography.The left atrial storage period strain(LASr),conduit longitudinal strain(LAScd)and contractile longitudinal strain(LASct)were measured by 2D-STI.The maximum and minimum left atrial volumes,indexed to body surface area,to obtain left atrial volume index(LAVImax,LAVImin),left atrial emptying fraction(LAEF)and left atrial expansion index(LAEI)were measured by RT-3DE.Differences of above parameters between the two groups before and 6 months after catheter ablation were compared.Binary Logistic regression analysis was used to analyze the influencing factors for improvement of mitral regurgitation after catheter ablation in AFMR patients,and receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of each factor in predicting the efficacy of catheter ablation.Results Compared with the results before catheter ablation,LAD,MAD,LAVImax,LAVImin were decreased,while LASr,LAScd,LASct,LAEF and LAEI increased at 6 months after-ablation in both improvement and non-improvement groups(all P<0.05).Moreover,LAD,LAVImax and LAVImin in the improvement group were lower than those in the non-improvement group,while LASr and LAScd were higher than those in the non-improvement group,and the differences were statistically significant(all P<0.05).Binary Logistic regression analysis showed that the MAD,LASr were independent predictors of improvement of mitral regurgitation after catheter ablation in AFMR patients(OR=5.552,0.733,both P=0.031).ROC curve analysis showed that the area under the curve of MAD and LASr in predicting improvement of mitral regurgitation in AFMR patients were 0.775 and 0.735,respectively,with cut-off value were 3.35 cm and 18.05%,respectively.Conclusion 2D-STI and RT-3DE can accurately evaluate the efficacy of catheter ablation in patients with AFMR.Both MAD and LASr are independent predictors of improvement of mitral regurgitation after catheter ablation.
关键词
超声心动描记术,三维,实时/斑点追踪,二维/心房颤动/心房功能性二尖瓣反流/导管消融术Key words
Echocardiography,three-dimensional,real-time/Speckle tracking,two-dimensional/Atrial fibrillation/Atrial functional mitral regurgitation/Catheter ablation引用本文复制引用
出版年
2024
NETL
NSTL
维普
万方数据