在收缩期评估左心房壁运动障碍，作为因持续性心房颤动进行电复律后心房颤动复发的预测指标。
Left atrial wall dyskinesia assessed during contractile phase as a predictor of atrial fibrillation recurrence after electrical cardioversion performed due to persistent atrial fibrillation.
作者信息
Wałek Paweł, Ciesla Elzbieta, Gorczyca Iwona, Wożakowska-Kapłon Beata
机构信息
Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce.
1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland.
出版信息
Medicine (Baltimore). 2020 Dec 4;99(49):e23333. doi: 10.1097/MD.0000000000023333.
Direct current cardioversion (DCCV) is one of the basic methods for restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). Left atrial (LA) strain is one of the parameters used to assess the risk of AF recurrence following DCCV. Assessing the strain also allows for the detection of segmental disorders of LA wall contractility, including dispersion or dyskinesia. In the present study, we determined the predictive value of LA wall dyskinesia in assessing the risk of AF recurrence after DCCV. We performed a comprehensive echocardiography in 89 patients with persistent AF following successful DCCV. We assessed the strain and strain rate in the reservoir (r), conduit, and contractile (ct) phases by using speckle tracking echocardiography. Dyskinesia was diagnosed when the strain rate of any segment of the LA wall displayed positive values during contraction. After 12 months, 47.2% of patients maintained SR. Patients who maintained SR had a significantly lower LA strain (LAS)r assessed in the apical 4-chamber view (4c) (11.38 ± 4.63 vs 14.54 ± 5.11; P = .004) and 2-chamber view (2c) (11.05 ± 4.1 vs 14.93 ± 6.82%; P = .006), LASct4c (2.51 ± 2.3 vs 5.09 ± 3.29%; P < .001), LASct2c (3.6 ± 2.98 vs 5.67 ± 4.23%; P = .008), peak strain rate (pLASR) ct4c (0.36 ± 0.24 s vs 0.62 ± 0.4; P < .001) and pLASRct2c (0.49 ± 0.30 vs 0.79 ± 0.53 s; P = .01). LA dyskinesia was observed less frequently in the 4c view in patients who maintained SR (59.57 vs 17.5%; P < .001). Multivariable logistic regression showed that the LASct4c (odds ratio (OR) 0.78; 95%CI 0.63-0.97; P = .027) and LA dyskinesia observed in the 4c view (OR 3.53; 95%CI 1.16-10.76; P = .027) were significant independent predictors of AF recurrence at 12 months. We conclude that LA dyskinesia observed in the 4c view and LASct4c are independent risk factors for AF recurrence following DCCV.
直流电复律（DCCV）是恢复心房颤动（AF）患者窦性心律（SR）的基本方法之一。左心房（LA）应变是用于评估DCCV后AF复发风险的参数之一。评估应变还可检测LA壁收缩功能的节段性障碍，包括离散或运动障碍。在本研究中，我们确定了LA壁运动障碍在评估DCCV后AF复发风险中的预测价值。我们对89例成功进行DCCV后的持续性AF患者进行了全面的超声心动图检查。我们使用斑点追踪超声心动图评估了心房贮备（r）、管道和收缩（ct）期的应变和应变率。当LA壁任何节段的应变率在收缩期显示正值时，诊断为运动障碍。12个月后，47.2%的患者维持窦性心律。维持窦性心律的患者在经胸超声心动图四腔心（4c）视图（11.38±4.63 vs 14.54±5.11；P = 0.004）和两腔心（2c）视图（11.05±4.1 vs 14.93±6.82%；P = 0.006）中评估的LA应变（LAS）r显著更低，LASct4c（2.51±2.3 vs 5.09±3.29%；P < 0.001），LASct2c（3.6±2.98 vs 5.67±4.23%；P = 0.008），峰值应变率（pLASR）ct4c（0.36±0.24 s vs 0.62±0.4；P < 0.001）和pLASRct2c（0.49±0.30 vs 0.79±0.53 s；P = 0.01）。在维持窦性心律的患者中，4c视图中观察到的LA运动障碍较少（59.57 vs 17.5%；P < 0.001）。多变量逻辑回归显示，LASct4c（比值比（OR）0.78；95%CI （0.63 - 0.97）；P = 0.027）和4c视图中观察到的LA运动障碍（OR 3.53；95%CI （1.16 - 10.76）；P = 0.027）是12个月时AF复发的显著独立预测因素。我们得出结论，4c视图中观察到的LA运动障碍和LASct4c是DCCV后AF复发的独立危险因素。
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