Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan.
Eur Heart J Cardiovasc Imaging. 2013 Aug;14(8):752-7. doi: 10.1093/ehjci/jes241. Epub 2012 Nov 8.
Diastolic late mitral annular velocity (a') measured by transthoracic echocardiography (TTE) is reported to represent left atrial (LA) pump function and the severity of LA remodelling. The purpose of this study is to investigate the association between a' and LA blood stasis in patients with non-valvular paroxysmal atrial fibrillation.
We enrolled 138 consecutive patients with non-valvular paroxysmal atrial fibrillation who had spontaneous sinus rhythm at the time of echocardiography. Using TTE, a' was determined as an average of tissue Doppler velocities measured at septal and lateral mitral annuli. Transoesophageal echocardiography was also performed on the same day as TTE, and spontaneous echo contrast (SEC) and LA appendage flow velocity were examined. Spontaneous echo contrast was observed in 21 (15%) patients. Patients in the lowest quartile of a' (≤6.4 cm/s) demonstrated SEC more frequently (44 vs. 6%, P < 0.0001) and had lower LA appendage flow velocity (39 ± 13 vs. 53 ± 16 cm/s, P < 0.0001) than those in the other quartiles. Receiver-operating characteristic curve analysis showed that the best cut-off value of a' was 7.0 cm/s for the prediction of SEC with a sensitivity of 80%, specificity of 81%, and predictive accuracy of 80%. Multivariate analysis revealed that decreased a' (OR = 0.61, P = 0.0026) was independently associated with SEC.
Decreased a' may be a useful parameter for the estimation of LA blood stasis in patients with paroxysmal atrial fibrillation.
经胸超声心动图（TTE）测量的舒张晚期二尖瓣环速度（a'）被报道可代表左心房（LA）泵功能和 LA 重构的严重程度。本研究旨在探讨阵发性非瓣膜性心房颤动患者中 a'与 LA 血瘀之间的关系。
我们纳入了 138 例连续的阵发性非瓣膜性心房颤动患者，这些患者在进行超声心动图检查时具有自发窦性节律。使用 TTE，通过测量间隔和外侧二尖瓣环的组织多普勒速度来确定 a'。同一天还进行了经食管超声心动图检查，检查了自发性回声对比（SEC）和 LA 附属物血流速度。在 21 例（15%）患者中观察到自发性回声对比。在 a'最低四分位数（≤6.4cm/s）的患者中，SEC 的发生率更高（44%比 6%，P<0.0001），LA 附属物血流速度更低（39±13cm/s 比 53±16cm/s，P<0.0001）。受试者工作特征曲线分析显示，a'的最佳截断值为 7.0cm/s，用于预测 SEC 的敏感性为 80%，特异性为 81%，预测准确性为 80%。多变量分析显示，a'降低（OR=0.61，P=0.0026）与 SEC 独立相关。
a'降低可能是评估阵发性心房颤动患者 LA 血瘀的有用参数。
