Tainan Hospital Sin-Hua Branch, Tainan, Taiwan.
J Am Soc Echocardiogr. 2011 May;24(5):513-9. doi: 10.1016/j.echo.2011.01.016. Epub 2011 Feb 24.
The objective of this study was to investigate myocardial deformation of the left atrium (LA) assessed by two-dimensional speckle tracking echocardiography in patients with permanent atrial fibrillation (AF) and its value for risk stratification for stroke.
We recruited 66 consecutive patients with permanent AF who were referred to our echocardiography laboratory for evaluation. These patients were divided into two groups according to the presence of previous stroke or not.
Peak positive longitudinal strain (LASp) during atrial filling, peak strain rate in the reservoir phase of LA (LASRr), and peak strain rate in the conduit phase (LASRc) were identified from LA strain and strain rate curves. The ratio of peak early filling velocity (E) of mitral inflow to early diastolic annulus velocity (E') of the medial annulus (E/E') was calculated. LASp (10.44% ± 4.2% vs. 15.69% ± 5.1%, P < .001), LASRr (1.09 ± 0.27 1/s vs. 1.37 ± 0.32 1/s, P = .001), and LASRc (-1.28 ± 0.38 1/s vs. -1.62 ± 0.43 1/s, P = .002) were significantly lower in patients with AF with stroke than those without stroke. By multivariate analysis controlling for age, LA volume index, and left ventricular ejection fraction, LASp (OR 0.787, 95% CI, 0.639-0.968, P = .023) and LASRr (OR 0.019, 95% CI, 0.001-0.585, P = .023) were independently associated with stroke but not LASRc, E', and E/E' ratio.
Decreased LASp and LASRr were independently associated with stroke in patients with permanent AF.
本研究旨在通过二维斑点追踪超声心动图评估永久性心房颤动（AF）患者的左心房（LA）心肌变形，并探讨其对卒中风险分层的价值。
我们招募了 66 例因评估原因被转诊至超声心动图实验室的连续永久性 AF 患者。根据患者是否有既往卒中史将其分为两组。
从 LA 应变和应变率曲线上识别出 LA 充盈期峰值纵向应变（LASp）、LA 储集期应变率峰值（LASRr）和 LA 传导期应变率峰值（LASRc）。计算二尖瓣流入道早期充盈速度（E）与内侧瓣环舒张早期速度（E'）的比值（E/E'）。与无卒中的 AF 患者相比，有卒中的 AF 患者的 LASp（10.44%±4.2% vs. 15.69%±5.1%，P<0.001）、LASRr（1.09±0.27 1/s vs. 1.37±0.32 1/s，P=0.001）和 LASRc（-1.28±0.38 1/s vs. -1.62±0.43 1/s，P=0.002）明显降低。多变量分析控制年龄、左心房容积指数和左心室射血分数后，LASp（OR 0.787，95%CI，0.639-0.968，P=0.023）和 LASRr（OR 0.019，95%CI，0.001-0.585，P=0.023）与卒中独立相关，但 LASRc、E'和 E/E'比值与卒中无关。
在永久性 AF 患者中，LASp 和 LASRr 的降低与卒中独立相关。
