左心耳血流速度对预测非瓣膜性心房颤动患者复律成功的临床价值

Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation.

作者信息

Pálinkás A, Antonielli E, Picano E, Pizzuti A, Varga A, Nyúzó B, Alegret J M, Bonzano A, Tanga M, Coppolino A, Forster T, Baralis G, Delnevo F, Csanády M

机构信息

2nd Department of Medicine and Cardiology Center, Albert Szent-Györgyi Medical Faculty, University of Sciences, Szeged, Hungary.

出版信息

Eur Heart J. 2001 Dec;22(23):2201-8. doi: 10.1053/euhj.2001.2891.

DOI:10.1053/euhj.2001.2891

PMID:11913482

Abstract

BACKGROUND

Echocardiographic parameters for predicting cardioversion outcome in patients with non-valvular atrial fibrillation are not accurately defined.

OBJECTIVE

To evaluate the role of left atrial appendage flow velocity detected by transoesophageal echocardiography for prediction of cardioversion outcome in patients with non-valvular atrial fibrillation enrolled in a prospective. multicentre, international study.

METHODS

Four hundred and eight patients (257 males, mean age: 66 +/- 10 years) with non-valvular atrial fibrillation lasting more than 48 h but less than 1 year underwent transthoracic echocardiography and transoesophageal echocardiography before either electrical (n=324) or pharmacological (n=84) cardioversion.

RESULTS

Cardioversion was successful in restoring sinus rhythm in 328 (80%) and unsuccessful in 80 patients (20%). Mean left atrial appendage peak emptying flow velocity was significantly higher in patients with successful than in those with unsuccessful cardioversion (32.4 +/- 17.7 vs 23.5 +/- 13.6 cm x s(-1); P<0.0001). At multivariate logistic regression analysis, three parameters proved to be independent predictors of cardioversion success: the atrial fibrillation duration <2 weeks (P=0.011, OR=4.9, CI 95%=1.9-12.7), the mean left atrial appendage flow velocity >31 cm x s(-1) (P=0.0013, OR=2.8, CI 95%=1.5-5.4) and the left atrial diameter <47 mm (P=0.093, OR=2.0, CI 95%=1.2-3.4). These independent predictors of cardioversion success outperformed other univariate predictors such as left ventricular end-diastolic diameter <58 mm, ejection fraction >56% and the absence of left atrial spontaneous echo contrast.

CONCLUSION

In patients with non-valvular atrial fibrillation, measurement of the left atrial appendage flow velocity profile by transoesophageal echocardiography before cardioversion provides valuable information for prediction of cardioversion outcome.

摘要

背景

用于预测非瓣膜性心房颤动患者复律结果的超声心动图参数尚未得到准确界定。

目的

在一项前瞻性、多中心、国际研究中，评估经食管超声心动图检测的左心耳血流速度对非瓣膜性心房颤动患者复律结果预测的作用。

方法

408例（257例男性，平均年龄：66±10岁）非瓣膜性心房颤动持续时间超过48小时但少于1年的患者，在进行电复律（n = 324）或药物复律（n = 84）之前接受了经胸超声心动图和经食管超声心动图检查。

结果

328例（80%）患者复律成功恢复窦性心律，80例（20%）患者复律失败。复律成功患者的平均左心耳峰值排空血流速度显著高于复律失败患者（32.4±17.7 vs 23.5±13.6 cm·s⁻¹；P<0.0001）。在多因素逻辑回归分析中，三个参数被证明是复律成功的独立预测因素：心房颤动持续时间<2周（P = 0.011，OR = 4.9，95%CI = 1.9 - 12.7）、平均左心耳血流速度>31 cm·s⁻¹（P = 0.0013，OR = 2.8，95%CI = 1.5 - 5.4）和左心房直径<47 mm（P = 0.093，OR = 2.0，95%CI = 1.2 - 3.4）。这些复律成功的独立预测因素优于其他单因素预测因素，如左心室舒张末期直径<58 mm、射血分数>56%以及无左心房自发回声增强。