心房颤动时左心房及左心耳的四维血流动力学
Left Atrial and Left Atrial Appendage 4D Blood Flow Dynamics in Atrial Fibrillation.
作者信息
Markl Michael, Lee Daniel C, Furiasse Nicholas, Carr Maria, Foucar Charles, Ng Jason, Carr James, Goldberger Jeffrey J
机构信息
From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.).
出版信息
Circ Cardiovasc Imaging. 2016 Sep;9(9):e004984. doi: 10.1161/CIRCIMAGING.116.004984.
BACKGROUND
Atrial 4D flow magnetic resonance imaging was used for the characterization of left atrial (LA) and left atrial appendage (LAA) flow dynamics in patients with atrial fibrillation (AF).
METHODS AND RESULTS
4D flow magnetic resonance imaging measured in vivo 3D blood flow velocities in 60 AF patients and 15 controls. Anatomic maps of LA and LAA stasis and velocity were calculated to quantify atrial peak velocity, mean velocity, and stasis (velocities <0.1 m/s). In a substudy with 30 AF patients, 4D flow metrics were compared with Doppler transesophageal echocardiography. For all 15 controls, LAA mean and peak velocities were consistently lower (by 21%/12%; P<0.001) while LAA stasis was higher (by 58%; P<0.001) compared with the LA. In contrast, lower LAA velocity and increased LAA stasis were only found in a fraction (38 of 60) of AF patients. In AF patients, increased CHA2DS2-VASc score was associated with significantly (P<0.043) reduced LA velocities and elevated stasis. There was a heterogeneous expression of atrial flow dynamics, and 25% to 68% of AF patients demonstrated flow in the normal range: 25%/68% for LA/LAA stasis and 38%/60% for LA/LAA peak velocities. Transesophageal echocardiography velocities modestly but significantly (P<0.05) correlated with 4D flow-based LA velocities (r=0.41) and stasis (r=-0.39).
CONCLUSIONS
AF resulted in overall impaired but individually variable flow dynamics in both the LA and LAA. AF patients demonstrated atrial flow in the normal range, despite elevated CHA2DS2-VASc score.
背景
心房四维血流磁共振成像用于表征心房颤动（AF）患者的左心房（LA）和左心耳（LAA）血流动力学。
方法与结果
对60例AF患者和15例对照者进行四维血流磁共振成像，测量体内三维血流速度。计算LA和LAA的血流淤滞和速度的解剖图，以量化心房峰值速度、平均速度和血流淤滞（速度<0.1 m/s）。在一项对30例AF患者的子研究中，将四维血流指标与经食管多普勒超声心动图进行比较。与LA相比，所有15例对照者的LAA平均速度和峰值速度持续较低（分别低21%/12%；P<0.001），而LAA血流淤滞较高（高58%；P<0.001）。相比之下，仅在部分（60例中的38例）AF患者中发现LAA速度降低和LAA血流淤滞增加。在AF患者中，CHA2DS2-VASc评分升高与LA速度显著降低（P<0.043）和血流淤滞升高相关。心房血流动力学存在异质性表达，25%至68%的AF患者表现为正常范围内的血流：LA/LAA血流淤滞为25%/68%，LA/LAA峰值速度为38%/60%。经食管超声心动图速度与基于四维血流的LA速度（r=0.41）和血流淤滞（r=-0.39）呈中度但显著（P<0.05）相关。
结论
AF导致LA和LAA的整体血流动力学受损，但个体存在差异。尽管CHA2DS2-VASc评分升高，但AF患者仍表现出正常范围内的心房血流。
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