Lin Mingjie, Hao Li, Cao Yuan, Xie Fei, Han Wenqiang, Rong Bing, Zhao Yachao, Zhong Jingquan
The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan, 250012, China.
Int J Cardiovasc Imaging. 2019 Mar;35(3):427-435. doi: 10.1007/s10554-018-1457-3. Epub 2018 Oct 6.
Dissipative energy loss (EL), an index of inefficient blood flow, has not been studied in patients with atrial fibrillation (AF). We therefore assessed the effect of AF and of successful catheter ablation on left ventricular (LV) EL and global longitudinal strain (GLS) to explore the effect of inefficient blood flow on LV remodeling. In 53 patients undergoing catheter ablation for AF (AF group), LV EL (in mW/m) was evaluated by vector flow mapping (VFM) during systole (ELsys), early diastole (ELed) and atrial contraction phase (ELac), and GLS was calculated by two-dimensional tissue tracking (2DTT). Of the 53 patients, 37 patients who sustained sinus rhythm and completed echocardiographic evaluation at baseline and at 3 and 6 months follow-up were examined for change in EL and GLS. The latter parameters also were assessed in 44 age- and sex-matched controls. At baseline in AF group, ELsys and ELed were significantly higher (3.97 ± 2.29 vs. 3.14 ± 1.01; and 9.22 ± 5.01 vs. 3.89 ± 1.51; both P < 0.05, respectively), and GLS was lower (- 16.66 ± 3.50 vs. - 19.95 ± 2.40, P < 0.05) than in controls. During follow-up after catheter ablation, ELsys and ELed significantly improved at 3 months, and almost normalized at 6 months (both P < 0.05); GLS also improved significantly (P < 0.05). In multivariate logistic regression analysis, ELed was the only independent predictor for maintenance of sinus rhythm at 1-year follow-up (hazard ratio, 1.254; 95% confidence interval 1.073-1.467). VFM and 2DTT revealed impaired LV EL and GLS in patients with AF. Successful catheter ablation appeared to ameliorate impairment in intraventricular flow and mechanics.
耗散能量损失（EL）作为血流低效的一个指标，尚未在心房颤动（AF）患者中进行研究。因此，我们评估了AF以及成功的导管消融对左心室（LV）EL和整体纵向应变（GLS）的影响，以探究血流低效对LV重塑的影响。在53例接受AF导管消融的患者（AF组）中，通过向量血流图（VFM）在收缩期（ELsys）、舒张早期（ELed）和心房收缩期（ELac）评估LV EL（单位为mW/m），并通过二维组织追踪（2DTT）计算GLS。在这53例患者中，对37例维持窦性心律并在基线以及随访3个月和6个月时完成超声心动图评估的患者进行EL和GLS变化的检查。还在44例年龄和性别匹配的对照者中评估了后述参数。在AF组基线时，ELsys和ELed显著更高（分别为3.97±2.29对3.14±1.01；以及9.22±5.01对3.89±1.51；均P<0.05），且GLS低于对照组（-16.66±3.50对-19.95±2.40，P<0.05）。在导管消融后的随访期间，ELsys和ELed在3个月时显著改善，在6个月时几乎恢复正常（均P<0.05）；GLS也显著改善（P<0.05）。在多因素逻辑回归分析中，ELed是1年随访时窦性心律维持的唯一独立预测因素（风险比，1.254；95%置信区间1.073 - 1.467）。VFM和2DTT显示AF患者存在LV EL和GLS受损。成功的导管消融似乎改善了心室内血流和力学的受损情况。
