Motoki Hirohiko, Koyama Jun, Tomita Takeshi, Aizawa Kazunori, Kasai Hiroki, Koshikawa Megumi, Izawa Atsushi, Kumazaki Setsuo, Takahashi Masafumi, Ikeda Uichi
Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Japan.
Echocardiography. 2011 Mar;28(3):289-97. doi: 10.1111/j.1540-8175.2010.01312.x. Epub 2010 Nov 12.
Early diastolic velocity of the mitral annulus and transmitral flow propagation velocity are reported as more reliable determinants of left ventricular diastolic function in patients with atrial fibrillation than are transmitral Doppler indices. This study aimed to test the hypothesis that transmitral flow curve shows pseudorestrictive pattern during rate-controlled atrial fibrillation.
Thirteen paroxysmal atrial fibrillation patients were monitored for three phases: before atrial fibrillation, during atrial fibrillation, and after the recovery of atrial fibrillation to sinus rhythm. Standard two-dimensional, color flow, and tissue Doppler echocardiography were performed. We compared the indices of left ventricular diastolic function among the three phases.
The early diastolic velocity of transmitral flow increased significantly during atrial fibrillation (before, 0.76 ± 0.19 m/sec; during, 0.86 ± 0.20 m/sec; after recovery to sinus rhythm, 0.73 ± 0.16 m/sec; P < 0.01). The deceleration time of early transmitral diastolic wave decreased during atrial fibrillation (182.5 ± 39.6 ms; 149.1 ± 38.7 ms; 184.0 ± 44.5 ms, respectively, P < 0.01). The early diastolic velocity of the mitral annulus increased during atrial fibrillation (5.37 ± 1.31 cm/sec; 7.29 ± 1.25 cm/sec; 5.37 ± 1.32 cm/sec; respectively, P < 0.01). The transmitral propagation velocity did not change significantly during atrial fibrillation.
Although conventional Doppler indices showed abnormal relaxation pattern, left ventricular diastolic function was preserved during rate-controlled atrial fibrillation, as determined from early diastolic velocity of the mitral annulus and transmitral flow propagation velocity.
二尖瓣环舒张早期速度和经二尖瓣血流传播速度被报道为心房颤动患者左心室舒张功能比经二尖瓣多普勒指标更可靠的决定因素。本研究旨在验证在心率控制的心房颤动期间经二尖瓣血流曲线显示假性限制性模式这一假设。
对13例阵发性心房颤动患者进行三个阶段的监测：心房颤动前、心房颤动期间和心房颤动恢复为窦性心律后。进行标准二维、彩色血流和组织多普勒超声心动图检查。我们比较了三个阶段左心室舒张功能指标。
经二尖瓣血流舒张早期速度在心房颤动期间显著增加（心房颤动前，0.76±0.19米/秒；心房颤动期间，0.86±0.20米/秒；恢复窦性心律后，0.73±0.16米/秒；P<0.01）。经二尖瓣舒张早期波的减速时间在心房颤动期间缩短（分别为182.5±39.6毫秒；149.1±38.7毫秒；184.0±44.5毫秒，P<0.01）。二尖瓣环舒张早期速度在心房颤动期间增加（分别为5.37±1.31厘米/秒；7.29±1.25厘米/秒；5.37±1.32厘米/秒；P<0.01）。经二尖瓣血流传播速度在心房颤动期间无显著变化。
尽管传统多普勒指标显示舒张功能异常，但根据二尖瓣环舒张早期速度和经二尖瓣血流传播速度判断，在心率控制的心房颤动期间左心室舒张功能得以保留。
