二维斑点追踪超声心动图评价持续性心房颤动转复后机械心房的恢复。

Mechanical atrial recovery after cardioversion in persistent atrial fibrillation evaluated by bidimensional speckle tracking echocardiography.

机构信息

Department of Cardiology, Ospedale San Giuseppe MultiMedica.

Department of Medicine and Surgery, University of Milano-Bicocca, Milano.

出版信息

J Cardiovasc Med (Hagerstown). 2019 Nov;20(11):745-751. doi: 10.2459/JCM.0000000000000864.

DOI:10.2459/JCM.0000000000000864

PMID:31483328

Abstract

BACKGROUND

Atrial fibrillation induces reversible electrical and mechanical modifications (atrial remodeling). Atrial stunning is a mechanical dysfunction with preserved bioelectrical function, occurring after successful atrial fibrillation electrical cardioversion (ECV). Two-dimensional speckle tracking echocardiography is a new technology for evaluating atrial mechanical function. We assessed atrial mechanical function after ECV with serial two-dimensional speckle tracking echocardiography evaluations. The investigated outcome was left atrium mechanical recovery within 3 months.

METHODS

A total of 36 patients [mean age 73 (7.9) years, 23 males] with persistent atrial fibrillation underwent conventional transthoracic and transesophageal echocardiography before ECV. Positive global atrial strain (GSA+) was assessed at 3 h, 1, 2, 3, 4 weeks and 3 months after ECV. Mechanical recovery was defined as the achievement of a GSA+ value of 21%.

RESULTS

Independent predictors of GSA+ immediately after ECV (basal GSA+) were E/e' ratio and left atrial appendage anterograde flow velocity. During the follow-up, 25% of patients suffered atrial fibrillation recurrence. In 12/36 patients (33%) left atrium mechanical recovery was detected (mechanical recovery group), while in 15/36 (42%) recovery did not occur (no atrial mechanical recovery group). At univariate analysis, the variables associated with recovery, were basal GSA+ (P = 0.015) and maximal velocity left atrial appendage (P = 0.022). Female sex (P = 0.038), N-terminal pro-B type natriuretic peptide (P = 0.013), E/e' (P = 0.042) and the indexed left atrium volume (P = 0.019) were associated with the lack of left atrium mechanical recovery.

CONCLUSION

In almost half of the patients, the left atrium did not resume mechanical activity within the 3 months after ECV, despite sinus rhythm recovery. The left atrium of these patients was larger, stiffer and their E/E' was higher, suggesting a higher endocavitary pressure compared with mechanical recovery patients. These findings might suggest an increased thromboembolic risk.

摘要

背景

心房颤动可引起可逆转的电和机械改变（心房重构）。心房顿抑是一种机械功能障碍，伴有保留的生物电功能，发生在成功的心房颤动电复律（ECV）后。二维斑点追踪超声心动图是评估心房机械功能的新技术。我们通过连续的二维斑点追踪超声心动图评估来评估 ECV 后的心房机械功能。研究结果是 3 个月内左心房机械恢复。

方法

36 例持续性心房颤动患者[平均年龄 73（7.9）岁，23 例男性]在 ECV 前接受了常规经胸和经食管超声心动图检查。在 ECV 后 3 小时、1 周、2 周、3 周和 4 周评估整体心房应变（GSA+）。机械恢复定义为达到 GSA+值≥21%。

结果

ECV 后即刻 GSA+的独立预测因子是 E/e' 比值和左心耳前向血流速度。在随访期间，25%的患者发生心房颤动复发。在 36 例患者中有 12 例（33%）检测到左心房机械恢复（机械恢复组），而在 15 例患者中（42%）未发生恢复（无左心房机械恢复组）。在单变量分析中，与恢复相关的变量是基础 GSA+（P=0.015）和左心耳最大速度（P=0.022）。女性（P=0.038）、N 端脑利钠肽前体（P=0.013）、E/e'（P=0.042）和左心房指数容积（P=0.019）与左心房机械恢复缺失相关。