Akdeniz Bahri, Badak Ozer, Bariş Nezihi, Aslan Ozgür, Kirimli Onder, Göldeli Ozhan, Güneri Sema
Department of Cardiology, Dokuz Eylül University School of Medicine, Izmir, Turkey.
Tohoku J Exp Med. 2006 Mar;208(3):243-50. doi: 10.1620/tjem.208.243.
Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 +/- 0.14 vs 0.27 +/- 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (> 0.28 m/sec, odds ratio = 2.8 ; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area (p = 0.18) and LAA ejection fraction (p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion.
对于经过适当选择的房颤患者，通过电复律恢复窦性心律是一种治疗选择。确定房颤患者电复律结果的预测因素很重要。临床和传统超声心动图参数对预测复律结果的预测价值有限。左心耳（LAA）功能可能反映左心房收缩功能，其在预测复律结果中的作用仍不明确。我们进行了一项单中心前瞻性研究，以评估LAA功能在预测房颤患者复律成功中的作用。163例房颤患者在电复律前接受了经胸和经食管超声心动图（TEE）检查。检查了LAA功能，包括LAA峰值流速、LAA面积和LAA射血分数。133例患者复律成功，30例患者复律失败。复律成功患者的平均LAA峰值排空流速显著高于复律失败患者（0.34±0.14 vs 0.27±0.1 m/秒；p = 0.013）。在多因素逻辑回归分析中，只有LAA流速（>0.28 m/秒，优势比=2.8；p = 0.03）被证明是复律成功的独立预测因素。复律成功组和失败组之间的LAA面积（p = 0.18）和LAA射血分数（p = 0.52）没有差异。因此，在TEE引导的复律前，测量LAA流速可为预测房颤患者的复律结果提供有价值的信息。
