窦性心律二尖瓣狭窄患者的左心耳功能

Left atrial appendage function in patients with mitral stenosis in sinus rhythm.

作者信息

Gölbaşi Z, Ciçek D, Canbay A, Uçar O, Bayol H, Aydogdu S

机构信息

Ankara Numune Education and Research Hospital, Department of Cardiology, Ankara, Turkey.

出版信息

Eur J Echocardiogr. 2002 Mar;3(1):39-43. doi: 10.1053/euje.2001.0110.

DOI:10.1053/euje.2001.0110

PMID:12067532

Abstract

AIMS

Left atrial appendage thrombi are believed to be the source of embolism in patients with rheumatic mitral stenosis in atrial fibrillation. There are a few studies which search the effects of left atrial appendage dysfunction in patients with mitral stenosis in sinus rhythm.

METHODS AND RESULTS

Left atrial appendage function and flow patterns in 41 patients with rheumatic mitral stenosis in sinus rhythm and 11 healthy subjects were studied by transoesophageal echocardiography. Left atrial appendage flow profiles were recorded within the proximal third of the appendage. The left atrial appendage ejection fraction was expressed as (maximal area of appendage minimal area of appendage)/maximal area of appendage. In addition, two-dimensional imaging was used to determine the presence of spontaneous echocardiographic contrast and thrombus formation. Patients with mitral stenosis in sinus rhythm had significantly decreased left atrial appendage emptying and filling velocities compared to controls (0.40+/-0.15m/s vs 0.82+/-0.19 m/s and 0.42+/-0.21 m/s vs 0.68+/-0.28, respectively, P<0.001 and P<0.05). Compared with the control subjects, patients with mitral stenosis had significantly greater maximal area of the appendage and had reduced left atrial appendage ejection fraction (5.3+/-2.2 cm(2) vs 2.4+/-0.5 cm(2) and 50+/-16% vs 70+/-7%, respectively, P<0.001 and P<0.05). Of the patients with mitral stenosis in sinus rhythm, seven patients had spontaneous echocardiographic contrast and one of these had left atrial appendage thrombus. Compared with patients without spontaneous echocardiographic contrast, patients with spontaneous echocardiographic contrast had decreased left atrial appendage ejection fraction (33+/-21% vs 54+/-13%,P <0.01). One of the patients with mitral stenosis had central retinal artery occlusion, but thrombus was not observed in left atrial appendage.

CONCLUSION

The study found that left atrial appendage dysfunction may occur in patients with mitral stenosis in sinus rhythm.

摘要

目的

左心耳血栓被认为是风湿性二尖瓣狭窄合并房颤患者栓塞的来源。有少数研究探讨了窦性心律下二尖瓣狭窄患者左心耳功能障碍的影响。

方法与结果

通过经食管超声心动图研究了41例窦性心律的风湿性二尖瓣狭窄患者和11例健康受试者的左心耳功能及血流模式。在左心耳近端三分之一处记录左心耳血流曲线。左心耳射血分数表示为（心耳最大面积 - 心耳最小面积）/心耳最大面积。此外，使用二维成像确定是否存在自发超声造影和血栓形成。与对照组相比，窦性心律的二尖瓣狭窄患者左心耳排空和充盈速度显著降低（分别为0.40±0.15m/s对0.82±0.19m/s和0.42±0.21m/s对0.68±0.28，P<0.001和P<0.05）。与对照组相比，二尖瓣狭窄患者的心耳最大面积显著更大，左心耳射血分数降低（分别为5.3±2.2cm²对2.4±0.5cm²和50±16%对70±7%，P<0.001和P<0.05）。在窦性心律的二尖瓣狭窄患者中，7例有自发超声造影表现，其中1例有左心耳血栓形成。与无自发超声造影表现的患者相比，有自发超声造影表现的患者左心耳射血分数降低（33±21%对54±13%，P<0.01）。1例二尖瓣狭窄患者发生视网膜中央动脉阻塞，但左心耳未观察到血栓。