Fumagalli Stefano, Gabbai Debbie, Francini Sara, Rinaldi Marta Casalone, Pedri Stefano, Baldasseroni Samuele, Tarantini Francesca, Serio Claudia Di, Lonetto Giuseppe, Bari Mauro Di, Padeletti Luigi, Crijns Harry J, Marchionni Niccolò
Department of Experimental and Clinical Medicine, Division of Geriatric Cardiology and Medicine, Research Unit of Medicine of Aging, University of Florence and AOU Careggi, Florence, Italy.
ESAOTE SpA, Florence, Italy.
J Cardiovasc Echogr. 2014 Jan-Mar;24(1):10-17. doi: 10.4103/2211-4122.131987.
Atrial fibrillation (AF) is often associated with heart failure. Several studies have demonstrated that resumption of sinus rhythm (SR) improves cardiac output in the long-term. Aims of this study were to evaluate the acute variations of left ventricular (LV) performance, following successful external cardioversion (ECV) of persistent AF using longitudinal strain (LSt) analysis, and the influence of inflammation.
We enrolled 48 patients with AF (age: 73 ± 12 years, men: 83.3%). A standard transthoracic echocardiographic evaluation was performed before the procedure and 6 h later; this included the analysis of LV endocardial peak LSt, a measure of myocardial deformation. In the last 32 patients, plasma concentration of interleukin-6 (IL-6) was also determined.
Restoration of SR led to the decrease of heart rate (HR) (74 ± 21 vs 64 ± 10 bpm, < 0.001) and LV end-systolic volume (30 ± 16 vs 27 ± 17 mL/m, = 0.001), and to the increase of LV end-diastolic volume (LVEDV) (56 ± 20 vs 60 ± 21 mL/m, = 0.036) and ejection fraction (EF) (48 ± 10 vs 57 ± 11%, < 0.001). Peak LSt improved in 43 (89.6%) patients (-12.9 ± 3.3 vs -18.0 ± 4.7%, < 0.001). Multivariate analysis ( = 0.729, < 0.001) showed that strain changes were directly correlated with basal HR and the appearance of atrial mechanical activity and inversely correlated with corrected thyroid dysfunction, LVEDV and the presence of a permanent pacemaker. Higher levels of IL-6 negatively affected LV performance improvement.
Effective ECV of AF determines a significant and fast improvement of LV performance, which is readily captured by LSt analysis. Inflammatory status may impact the response to SR restoration.
心房颤动（AF）常与心力衰竭相关。多项研究表明，恢复窦性心律（SR）可长期改善心输出量。本研究的目的是使用纵向应变（LSt）分析评估持续性房颤成功进行体外心脏复律（ECV）后左心室（LV）功能的急性变化以及炎症的影响。
我们纳入了48例房颤患者（年龄：73±12岁，男性：83.3%）。在手术前和术后6小时进行标准的经胸超声心动图评估；这包括对左心室心内膜峰值LSt的分析，这是一种心肌变形的测量方法。在最后32例患者中，还测定了白细胞介素-6（IL-6）的血浆浓度。
恢复SR导致心率（HR）降低（74±21对64±10次/分钟，<0.001）和左心室收缩末期容积降低（30±16对27±17 mL/m，=0.001），并导致左心室舒张末期容积（LVEDV）增加（56±20对60±21 mL/m，=0.036）和射血分数（EF）增加（48±10对57±11%，<0.001）。43例（89.6%）患者的峰值LSt得到改善（-12.9±3.3对-18.0±4.7%，<0.001）。多变量分析（=0.729，<0.001）显示，应变变化与基础心率和心房机械活动的出现直接相关，与校正后的甲状腺功能障碍、LVEDV和永久性起搏器的存在呈负相关。较高水平的IL-6对左心室功能的改善有负面影响。
房颤的有效ECV可显著快速改善左心室功能，LSt分析可轻松捕捉到这一变化。炎症状态可能会影响对SR恢复的反应。
