Cameli Matteo, Lunghetti Stefano, Mandoli Giulia Elena, Righini Francesca Maria, Lisi Matteo, Curci Valeria, Tommaso Cristina Di, Solari Marco, Nistor Dan, Gismondi Annalaura, Focardi Marta, Favilli Roberto, Mondillo Sergio
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
Department of Internal Medicine V, University of Medicine and Pharmacy Targu Mures, Romania.
J Atr Fibrillation. 2017 Dec 31;10(4):1641. doi: 10.4022/jafib.1641. eCollection 2017 Dec.
Atrial fibrillation (AF) has a high prevalence in the population and it is responsible for up to the 25% of the strokes in elderly people. The aim of our study was to assess the correlations of left atrial (LA) functional parameter, global peak atrial longitudinal strain (PALS), derived from speckle tracking echocardiography (STE), with transesophageal echocardiography (TEE) findings in patients with persistent AF undergoing TEE before electrical cardioversion or ablation procedures.
79 patients (58 males, 21 females) with persistent AF waiting for cardioversion were included in the study. The patients underwent conventional two-dimensional (2D) and 2D speckle tracking echocardiogram. PALS were measured in all subjects. Patients were divided into two groups according to the presence of reduced LA appendage (LAA) emptying velocity (<25 cm/s) and/or thrombus in the LAA at TEE examination.
Patients with reduced LAA emptying velocity and/or thrombus at TEE examination showed a significantly higher LA volume and increased E/E' ratio. 4-chamber, 2-chamber and global PALS were significantly lower in patients with reduced LAA emptying velocity and/or thrombus (6.8 ± 2.0% vs. 27.5 ± 5.4%, P < 0.0001; 8.6 ± 3.5% vs. 29.4 ± 7.1%, P < 0.0001; 7.9 ± 3.2% vs. 28.5 ± 6.1%, P <0.0001, respectively). Among all variables analyzed, global PALS demonstrated the highest diagnostic accuracy (AUC of 0.92) and, with a cut-off value less than 8.1%, good sensitivity and specificity of 87% and 94%, respectively, to predict LAA thrombus and/or reduced LAA emptying velocity.
心房颤动（AF）在人群中具有较高的患病率，并且在老年人中风中占比高达25%。我们研究的目的是评估在接受电复律或消融手术前进行经食管超声心动图（TEE）检查的持续性AF患者中，基于斑点追踪超声心动图（STE）得出的左心房（LA）功能参数——整体峰值心房纵向应变（PALS）与TEE检查结果之间的相关性。
本研究纳入了79例等待复律的持续性AF患者（58例男性，21例女性）。患者接受了常规二维（2D）和2D斑点追踪超声心动图检查。测量了所有受试者的PALS。根据TEE检查时左心耳（LAA）排空速度降低（<25 cm/s）和/或LAA内血栓的存在情况，将患者分为两组。
TEE检查发现LAA排空速度降低和/或有血栓的患者，其LA容积显著更高，E/E'比值增加。LAA排空速度降低和/或有血栓的患者，其四腔心、两腔心和整体PALS显著更低（分别为6.8±2.0%对27.5±5.4%，P<0.0001；8.6±3.5%对29.4±7.1%，P<0.0001；7.9±3.2%对28.5±6.1%，P<0.0001）。在所有分析变量中，整体PALS显示出最高的诊断准确性（曲线下面积为0.92），并且以低于8.1%的截断值，预测LAA血栓和/或LAA排空速度降低的敏感性和特异性分别为87%和94%，表现良好。
