Van Beeumen Katarina, Duytschaever Mattias, Tavernier Rene, Van de Veire Nico, De Sutter Johan
Department of Cardiology, University Hospital, Ghent, Belgium.
Am J Cardiol. 2007 Jan 1;99(1):79-83. doi: 10.1016/j.amjcard.2006.07.066. Epub 2006 Nov 9.
Heart failure (HF) is associated with atrial conduction delay. Color tissue Doppler imaging was used to evaluate intra- and interatrial asynchrony in patients with HF, patients with structural heart disease without HF, and controls. Twenty-three controls (mean age 65 +/- 13 years), 29 patients with structural heart disease without HF (mean age 68 +/- 9 years), and 29 patients with HF (mean age 67 +/- 9 years) were studied. Patients had no histories of atrial fibrillation. Echocardiographic color tissue Doppler imaging of the atria was performed. Measurements below the atrioventricular plane were selected on the right atrial (RA) free wall, interatrial septum (IAS), and left atrial (LA) free wall. The time difference from the onset of the P wave to the onset of the A wave at the right atrium (P-RA), the IAS (P-IAS), and the left atrium (P-LA) was measured. Asynchrony was defined as the differences between P-IAS and P-RA (RA asynchrony), P-LA and P-IAS (LA asynchrony), and P-LA and P-RA (interatrial asynchrony). In patients with HF, a significant increase in RA asynchrony was observed compared with controls and patients without HF (30 +/- 21 vs 12 +/- 13 and 14 +/- 15 ms, p <0.001). LA asynchrony was not different (19 +/- 26 vs 25 +/- 13 vs 25 +/- 14 ms, p = NS). Interatrial asynchrony was significantly increased in patients with HF (49 +/- 24 vs 37 +/- 9 and 39 +/- 17 ms, p = 0.04). There were moderate but significant correlations of RA asynchrony with log N-terminal-pro-B-type natriuretic peptide (r = 0.3, p = 0.01) and the ejection fraction (r = -0.4, p <0.001). In conclusion, in patients with HF, significant RA and interatrial asynchrony was documented, evaluated by noninvasive color tissue Doppler imaging. Asynchrony was related to N-terminal-pro-B-type natriuretic peptide and to the ejection fraction.
心力衰竭（HF）与心房传导延迟有关。采用彩色组织多普勒成像技术评估HF患者、无HF的结构性心脏病患者以及对照组的心房内和心房间不同步情况。研究了23名对照组患者（平均年龄65±13岁）、29名无HF的结构性心脏病患者（平均年龄68±9岁）和29名HF患者（平均年龄67±9岁）。患者均无房颤病史。对心房进行超声心动图彩色组织多普勒成像检查。在右心房（RA）游离壁、房间隔（IAS）和左心房（LA）游离壁上选择房室平面以下的测量点。测量从P波起始至右心房（P-RA）、IAS（P-IAS）和左心房（P-LA）处A波起始的时间差。不同步定义为P-IAS与P-RA之间的差值（RA不同步）、P-LA与P-IAS之间的差值（LA不同步）以及P-LA与P-RA之间的差值（心房间不同步）。与对照组和无HF的患者相比，HF患者的RA不同步显著增加（30±21 vs 12±13和14±15毫秒，p<0.001）。LA不同步无差异（19±26 vs 25±13 vs 25±14毫秒，p=无显著性差异）。HF患者的心房间不同步显著增加（49±24 vs 37±9和39±17毫秒，p=0.04）。RA不同步与N末端B型利钠肽原对数（r=0.3，p=0.01）和射血分数（r=-0.4，p<0.001）存在中度但显著的相关性。总之，在HF患者中，通过无创彩色组织多普勒成像记录到显著的RA和心房间不同步。不同步与N末端B型利钠肽原和射血分数有关。
