Yilmaz Remzi, Kasap Hasan, Baykan Merih, Durmus Ismet, Kaplan Sahin, Celik Sukru, Erdol Cevdet
The Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
Int J Cardiol. 2005 Jun 22;102(1):79-85. doi: 10.1016/j.ijcard.2004.04.004.
We studied tissue Doppler parameters in patients with atrial fibrillation following acute myocardial infarction, and their relation to P wave durations and P dispersion.
Echocardiographic examination was performed in 84 consecutive patients with first anterior acute myocardial infarction. In addition to other conventional echocardiographic parameters, the peak systolic (Sm), early diastolic (Em) and late diastolic (Am) velocities were obtained at the lateral corner of the mitral annulus by pulsed wave tissue Doppler. The Em/Am ratio and the ratio of early diastolic mitral inflow velocity to Em (E/Em), which is a marker of diastolic filling pressure, were calculated. Electrocardiogram was recorded from all patients on admission; P wave measurements were also performed.
Atrial fibrillation occurred in 20 (23.8%) of 84 patients. The patients with atrial fibrillation had significant reduction of Em (5.6+/-1.5 vs. 8.7+/-2.7 cm/s, p < 0.001), Em/Am (0.61+/-0.27 vs. 0.84+/-0.23, p = 0.001) and Sm (7.1+/-1.0 vs. 8.3+/-1.9 cm/s, p < 0.001) values compared with those without. The E/Em ratio (14.45+/-4.62 vs. 7.47+/-2.79, p < 0.001), P maximum (102+/-11 vs. 95+/-11 ms, p = 0.02) and P dispersion (35+/-7 vs. 26+/-7 ms, p < 0.001) were significantly higher in patients with atrial fibrillation than in those without. In all patients, P dispersion showed significant correlation with Em (r = -0.33, p = 0.002), Sm (r = -0.40, p < 0.001) and E/Em (r = 0.32, p = 0.003). When E/Em > or = 10 was used as cutpoint, atrial fibrillation could be predicted with a sensitivity of 90%, and a specificity of 84%.
The patients with atrial fibrillation following acute myocardial infarction have reduced systolic and diastolic mitral annular velocities and increased E/Em ratio, P maximum and P dispersion values compared to those without. P dispersion is correlated with systolic and diastolic left ventricular function after acute myocardial infarction. The E/Em ratio appears to be a useful parameter for assessing the risk of atrial fibrillation occurrence after anterior acute myocardial infarction.
我们研究了急性心肌梗死后房颤患者的组织多普勒参数，以及它们与P波时限和P波离散度的关系。
对84例连续性首次前壁急性心肌梗死患者进行超声心动图检查。除了其他常规超声心动图参数外，通过脉冲波组织多普勒在二尖瓣环外侧角获取收缩期峰值（Sm）、舒张早期（Em）和舒张晚期（Am）速度。计算Em/Am比值以及舒张早期二尖瓣血流速度与Em的比值（E/Em），E/Em是舒张期充盈压的一个指标。所有患者入院时均记录心电图；同时也进行P波测量。
84例患者中有20例（23.8%）发生房颤。房颤患者的Em（5.6±1.5 vs. 8.7±2.7 cm/s，p<0.001）、Em/Am（0.61±0.27 vs. 0.84±0.23，p = 0.001）和Sm（7.1±1.0 vs. 8.3±1.9 cm/s，p<0.001）值与未发生房颤的患者相比显著降低。房颤患者的E/Em比值（14.45±4.62 vs. 7.47±2.79，p<0.001）、P波最大值（102±11 vs. 95±11 ms，p = 0.02）和P波离散度（35±7 vs. 26±7 ms，p<0.001）显著高于未发生房颤的患者。在所有患者中，P波离散度与Em（r = -0.33，p = 0.002）、Sm（r = -0.40，p<0.001）和E/Em（r = 0.32，p = 0.003）均呈显著相关。当以E/Em≥10作为切点时，预测房颤的敏感性为90%，特异性为84%。
与未发生房颤的患者相比，急性心肌梗死后房颤患者的二尖瓣环收缩期和舒张期速度降低，E/Em比值、P波最大值和P波离散度增加。P波离散度与急性心肌梗死后左心室收缩和舒张功能相关。E/Em比值似乎是评估前壁急性心肌梗死后房颤发生风险的一个有用参数。
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