Sabry Al-Shimaa Mohamed, Mansour Heba Abd El-Kader, Abo El-Azm Tarek Helmy, Mostafa Shimaa Ahmed, Zahid Basant Samy
Cardiology Department, Faculty of Medicine, Benha University, Egypt.
Egypt Heart J. 2017 Dec;69(4):281-288. doi: 10.1016/j.ehj.2017.07.002. Epub 2017 Jul 29.
Detection of the echocardiographic predictors of post-operative atrial fibrillation in patients with rheumatic mitral valve disease undergoing mitral valve replacement.
The study included 50 patients with rheumatic mitral valve disease undergoing mitral valve replacement. Preoperative assessment included standard two-dimensional echocardiography to assess LA diameter, volume, and emptying fraction, LV volume and ejection fraction. TDI derived velocity, strain of the left atrium and speckle tracking to assess left ventricular function then postoperative follow up for 1 month for occurrence of atrial fibrillation.
The incidence of postoperative AF was 44%; these patients were significantly older ( = 0.001) and show higher prevalence of DM ( = 0.001) and HTN ( = 0.001). Also, LA diameters (antero-posterior, transverse and longitudinal) and LA volumes (maximal and minimal) were increased ( < 0.001), but no difference in LA emptying fraction ( > 0.05). Systolic LA strain and left ventricular global longitudinal strain were significantly reduced in those patients ( value <0.001). Echocardiographic predictors of AF were LA systolic strain ( value <0.001) and LV global longitudinal strain ( value = 0.003). Cutoff value for systolic LA strain ≤23 had sensitivity 90.91% and specificity 93.33% in predicting POAF. While, left ventricular global longitudinal strain ≤-14.9% had sensitivity 63.6% and specificity 100.0% in predicting AF.
LA systolic strain and LV global longitudinal strain were significant predictors of POAF. Echocardiographic parameters can identify patients at greater risk of developing POAF who can benefit from preventive measure and guide the selection of prosthesis.
检测行二尖瓣置换术的风湿性二尖瓣疾病患者术后房颤的超声心动图预测指标。
该研究纳入了50例行二尖瓣置换术的风湿性二尖瓣疾病患者。术前评估包括标准二维超声心动图，以评估左心房直径、容积和排空分数、左心室容积和射血分数。采用组织多普勒成像（TDI）得出的速度、左心房应变以及斑点追踪技术评估左心室功能，然后术后随访1个月观察房颤的发生情况。
术后房颤的发生率为44%；这些患者年龄显著更大（P = 0.001），糖尿病（P = 0.001）和高血压（P = 0.001）的患病率更高。此外，左心房直径（前后径、横径和纵径）和左心房容积（最大和最小）均增加（P < 0.001），但左心房排空分数无差异（P > 0.05）。这些患者的左心房收缩期应变和左心室整体纵向应变显著降低（P值<0.001）。房颤的超声心动图预测指标为左心房收缩期应变（P值<0.001）和左心室整体纵向应变（P值 = 0.003）。左心房收缩期应变≤23的临界值在预测术后房颤时敏感性为90.91%，特异性为93.33%。而左心室整体纵向应变≤ - 14.9%在预测房颤时敏感性为63.6%，特异性为100.0%。
左心房收缩期应变和左心室整体纵向应变是术后房颤的重要预测指标。超声心动图参数可识别发生术后房颤风险更高的患者，这些患者可从预防措施中获益，并指导人工瓣膜的选择。
