Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
Division of Cardiovascular Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Heart Rhythm. 2018 Jul;15(7):955-959. doi: 10.1016/j.hrthm.2018.02.022. Epub 2018 Mar 1.
Left atrial (LA) strain (ε) and ε rate (SR) analysis by 2-dimensional speckle tracking echocardiography is a novel method for functional assessment of the LA.
The purpose of this study was to determine the impact of left atrial appendage (LAA) exclusion by Lariat epicardial ligation on mechanical function of the LA by performing ε and SR analysis before and after the procedure.
A total of 66 patients who underwent successful LAA exclusion were included in the study. Of these 66 patients, 32 had adequate paired data for ε and SR analysis. SR during ventricular systole (LA-SRs) represents LA reservoir function, and SR during early ventricular diastole (LA-SRe) represents LA conduit function. ε and SR were determined from apical 4- and 2-chamber views using the electrocardiographic QRS as a reference point. LA volume index as surrogate for LA remodeling was measured from apical views.
Mean patient age was 70 ± 9.2 years. LAA ligation resulted in improved reservoir function (LA-SRs: pre 0.72, confidence interval [CI] 0.63-0.83 vs post 0.81, CI 0.73-0.98; P = .043) and conduit function (LA-SRe: pre 0.74, CI 0.67-0.99 vs post 0.89, CI 0.82-1.07; P = .025). LA volume index improved significantly with the Lariat (pre 35.4, CI 29.4-37.2 vs post 29.2, CI 28.2-35.9; P <.023).
LAA exclusion seems to improve mechanical function of the LA and results in reverse LA remodeling.
通过二维斑点追踪超声心动图进行左心房（LA）应变（ε）和 ε 率（SR）分析是一种评估 LA 功能的新方法。
本研究旨在通过在手术前后进行 ε 和 SR 分析，确定通过 Lariat 心外膜结扎术排除左心耳（LAA）对 LA 机械功能的影响。
共纳入 66 例成功接受 LAA 排除术的患者。其中 32 例患者有足够的 ε 和 SR 配对数据进行分析。心室收缩期 LA-SR（LA 储备功能）代表 LA 储器功能，而早期心室舒张期 LA-SRe（LA 传导功能）代表 LA 导管功能。ε 和 SR 是从心尖 4 腔和 2 腔视图中使用心电图 QRS 作为参考点确定的。LA 容积指数作为 LA 重构的替代指标从心尖视图中测量。
患者平均年龄为 70±9.2 岁。LAA 结扎导致储备功能改善（LA-SRs：术前 0.72，置信区间 [CI] 0.63-0.83 与术后 0.81，CI 0.73-0.98；P=0.043）和传导功能改善（LA-SRe：术前 0.74，CI 0.67-0.99 与术后 0.89，CI 0.82-1.07；P=0.025）。Lariat 术使 LA 容积指数显著改善（术前 35.4，CI 29.4-37.2 与术后 29.2，CI 28.2-35.9；P<.023）。
排除 LAA 似乎改善了 LA 的机械功能，并导致 LA 逆向重构。
