Mochizuki Atsushi, Yuda Satoshi, Fujito Takefumi, Kawamukai Mina, Muranaka Atsuko, Nagahara Daigo, Shimoshige Shinya, Hashimoto Akiyoshi, Miura Tetsuji
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-0061, Japan.
Division of Cardiology, Cardiovascular Center, Teine Keijinkai Hospital, Sapporo, Japan.
J Echocardiogr. 2017 Jun;15(2):79-87. doi: 10.1007/s12574-017-0329-5. Epub 2017 Feb 2.
Several studies have shown the utility of left atrial (LA) function determined by two-dimensional or three-dimensional speckle tracking echocardiography (2D- or 3D-STE) for identifying patients with paroxysmal atrial fibrillation (AF). However, whether 3D-STE is applicable for prediction of the recurrence of AF after catheter ablation (CA) remains unknown. We examined whether any 3D-STE parameters are better than 2D-STE parameters for the prediction of AF recurrence.
Forty-two patients with paroxysmal AF (58 ± 10 years old, 69% male) underwent 2D- and 3D-STE within 3 days before first-time CA. The global peak LA longitudinal, circumferential, and area strains during systole (3D-GLSs, -GCSs, and -GASs, respectively) and those just before atrial contraction (3D-GLSa, -GCSa, and -GASa, respectively) were determined by 3D-STE and standard deviations of times to peaks of regional LA strains were calculated as indices of LA dyssynchrony. In 2D-STE, global LA longitudinal strains during systole and just before atrial contraction (2D-GLSs and -GLSa) were determined.
During follow-up of 441 ± 221 days, 12 patients (29%) had AF recurrence. In the univariate Cox proportional hazard analysis, age [hazard ratio (HR): 1.08, p = 0.04], 3D-GCSs (HR: 0.91, p = 0.03), and 3D-GASs (HR: 0.95, p = 0.01) were predictors of AF recurrence, though associations of recurrence with 2D-STE parameters, indices of LA synchrony, and LA volume were not significant. Multivariable analysis showed that 3D-GASs was an independent predictor of AF recurrence (HR: 0.96, p = 0.048).
LA strain determined by 3D-STE is a novel and better predictor of AF recurrence after CA than that determined by 2D-STE or other known predictors.
多项研究表明，二维或三维斑点追踪超声心动图（2D-或3D-STE）测定的左心房（LA）功能在识别阵发性心房颤动（AF）患者方面具有实用性。然而，3D-STE是否适用于预测导管消融（CA）后AF的复发仍不清楚。我们研究了在预测AF复发方面，是否有任何3D-STE参数优于2D-STE参数。
42例阵发性AF患者（年龄58±10岁，69%为男性）在首次CA前3天内接受了2D-和3D-STE检查。通过3D-STE测定收缩期（分别为3D-GLSs、-GCSs和-GASs）及心房收缩前（分别为3D-GLSa、-GCSa和-GASa）的整体LA纵向、圆周和面积峰值应变，并计算局部LA应变峰值时间的标准差作为LA不同步指数。在2D-STE中，测定收缩期及心房收缩前的整体LA纵向应变（2D-GLSs和-GLSa）。
在441±221天的随访期间，12例患者（29%）发生AF复发。在单变量Cox比例风险分析中，年龄[风险比（HR）：1.08，p=0.04]、3D-GCSs（HR：0.91，p=0.03）和3D-GASs（HR：0.95，p=0.01）是AF复发的预测因素，尽管复发与2D-STE参数、LA同步指数和LA容积之间的关联不显著。多变量分析显示，3D-GASs是AF复发的独立预测因素（HR：0.96，p=0.048）。
与2D-STE或其他已知预测因素相比，3D-STE测定的LA应变是CA后AF复发的一种新的、更好的预测因素。
