经胸组织多普勒超声心动图评估左心耳功能
Assessment of left atrial appendage function with transthoracic tissue Doppler echocardiography.
作者信息
Uretsky Seth, Shah Ajay, Bangalore Sripal, Rosenberg Lauren, Sarji Rawa, Cantales Deborah R, Macmillan-Marotti Donna, Chaudhry Farooq A, Sherrid Mark V
机构信息
St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10019, USA.
出版信息
Eur J Echocardiogr. 2009 May;10(3):363-71. doi: 10.1093/ejechocard/jen339. Epub 2009 Feb 4.
AIMS
A transthoracic echocardiographic (TTE) parameter that would stratify atrial fibrillation (AF) risk would be useful. Tissue Doppler imaging can quantify left atrial appendage contraction velocity (LAA A(M)).
METHODS AND RESULTS
We studied 141 patients referred for transoesophageal echocardiogram (TEE); 48 were in AF. We obtained TEE and TTE LAA A(M) velocities from the LAA apex on the parasternal short-axis and apical two-chamber views. Adequate traces were obtained in 118 patients (84%). In these patients, we measured 5382 LAA A(M) velocity tracings. There was a strong correlation between LAA A(M) on TEE and TTE parasternal short-axis (r = 0.741; P < 0.0001) and apical two-chamber views (r = 0.729; P < 0.0001). Patients in AF had lower LAA A(M) than those with sinus rhythm on parasternal short-axis (12 +/- 5 vs. 23 +/- 7 cm/s, P < 0.0001) and apical two-chamber (14 +/- 5 vs. 23 +/- 8 cm/s, P < 0.0001) views. On parasternal short axis, LAA A(M) velocities were lower in patients with spontaneous echo contrast, 11 +/- 4 vs. 22 +/- 8 cm/s (P < 0.0001), and in those with thrombus, 8 +/- 2 cm/s (P < 0.0001). On apical two-chamber, LAA A(M) velocities were also lower with spontaneous echo contrast, 12 +/- 4 vs. 22 +/- 7 cm/s (P < 0.0001), and with thrombus, 10 +/- 4 cm/s (P < 0.0001). In patients with AF and TTE LAA A(M) < or =11 cm/s, we found that nearly one-third had LAA thrombus. In patients with AF and a history of stroke or transient ischaemic attack (TIA), LAA A(M) velocities were lower compared with those without history of stroke or TIA in the parasternal short-axis (9 +/- 3 vs. 13 +/- 5 cm/s, P = 0.02) and apical two-chamber views (11 +/- 3 vs. 15 +/- 6 cm/s, P = 0.008).
CONCLUSION
Acquiring and quantifying LAA A(M) contraction velocity is feasible on TTE in a high percentage of patients and correlates with TEE. LAA A(M) was lower in AF compared with sinus rhythm, with spontaneous echo contrast compared to without spontaneous echo contrast, and in AF patients with a history of stroke or TIA. Those with LAA thrombus had the lowest LAA A(M) velocities. LAA A(M) is a novel functional parameter that may prove useful for risk stratification of AF.
目的
一个能够对房颤（AF）风险进行分层的经胸超声心动图（TTE）参数将很有用。组织多普勒成像可以量化左心耳收缩速度（LAA A(M)）。
方法与结果
我们研究了141例接受经食管超声心动图（TEE）检查的患者；其中48例为房颤患者。我们从胸骨旁短轴和心尖两腔视图的心尖获取TEE和TTE的LAA A(M)速度。118例患者（84%）获得了足够的描记图。在这些患者中，我们测量了5382次LAA A(M)速度描记。TEE与TTE胸骨旁短轴（r = 0.741；P < 0.0001）和心尖两腔视图（r = 0.729；P < 0.0001）的LAA A(M)之间存在强相关性。房颤患者胸骨旁短轴（12±5 vs. 23±7 cm/s，P < 0.0001）和心尖两腔（14±5 vs. 23±8 cm/s，P < 0.0001）视图的LAA A(M)低于窦性心律患者。在胸骨旁短轴上，存在自发显影的患者LAA A(M)速度较低，为11±4 vs. 22±8 cm/s（P < 0.0001），有血栓的患者为8±2 cm/s（P < 0.0001）。在心尖两腔视图上，存在自发显影的患者LAA A(M)速度也较低，为12±4 vs. 22±7 cm/s（P < 0.0001），有血栓的患者为10±4 cm/s（P < 0.0001）。在房颤且TTE LAA A(M)≤11 cm/s的患者中，我们发现近三分之一有左心耳血栓。在有房颤且有中风或短暂性脑缺血发作（TIA）病史的患者中，胸骨旁短轴（9±3 vs. 13±5 cm/s，P = 0.02）和心尖两腔视图（11±3 vs. 15±6 cm/s，P = 0.008）的LAA A(M)速度低于无中风或TIA病史的患者。
结论
在高比例患者中，通过TTE获取和量化LAA A(M)收缩速度是可行的，且与TEE相关。与窦性心律相比，房颤患者的LAA A(M)较低；与无自发显影相比，有自发显影的患者LAA A(M)较低；有中风或TIA病史的房颤患者LAA A(M)较低。有左心耳血栓的患者LAA A(M)速度最低。LAA A(M)是一个新的功能参数，可能对房颤风险分层有用。
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