Zhen Xiao-Wen, Li Wen-Cai, Wang Hua, Song Nian-Peng, Zhong Lin
Department of Diagnostics, Binzhou Medical University, Yantai, China.
Department of Cardiology, Affiliated Yantai Yuhuangding Hospital, Qingdao University Medical College, Yantai, China.
Front Cardiovasc Med. 2022 Oct 24;9:1019472. doi: 10.3389/fcvm.2022.1019472. eCollection 2022.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, which is associated with cardiac dysfunction. This study aimed to compare the impairment severity of left ventricular strain and intra-ventricular dyssynchrony using echocardiography-derived velocity vector imaging in patients with different types of AF without heart failure.
168 non-valvular AF patients with normal left ventricular ejection fraction (98 paroxysmal AF patients and 70 persistent AF patients) and 86 healthy control subjects were included in this study. Regional and global left ventricular longitudinal and circumferential strain were measured. Time to regional peak longitudinal strain was measured and the standard deviation of all 12 segments (SDT-S) was used as a measure of intra-ventricular dyssynchrony.
Significantly lower GLS (-18.71 ± 3.00% in controls vs. -17.10 ± 3.01% in paroxysmal AF vs. -12.23 ± 3.25% in persistent AF, < 0.05) and GCS (-28.75 ± 6.34% in controls vs. -24.43 ± 6.86% in paroxysmal AF vs. -18.46 ± 6.42% in persistent AF, < 0.01) were observed in either persistent AF subjects or paroxysmal AF subjects compared with healthy control subjects ( < 0.05). The impairment was much worse in persistent AF subjects compared with paroxysmal AF subjects ( < 0.001). Intraventricular dyssynchrony was found in both persistent AF patients and paroxysmal AF patients, and it's worse in persistent AF patients (52 ± 18 ms in controls, 61 ± 17 ms in paroxysmal AF, and 70 ± 28 ms in persistent AF, < 0.05). Multivariate regression analysis revealed AF types were independent risk factors of GLS, GCS, and intraventricular dyssynchrony.
AF types were not only associated with impaired longitudinal and circumferential left ventricle mechanics but also intra-ventricular mechanical dyssynchrony. Worse systolic mechanics and intra-ventricular dyssynchrony were found in patients with persistent AF compared with these in patients with paroxysmal AF.
心房颤动（AF）是最常见的持续性心律失常，与心脏功能障碍有关。本研究旨在使用超声心动图衍生的速度向量成像比较不同类型无心力衰竭的房颤患者左心室应变和心室内不同步的损害严重程度。
本研究纳入168例左心室射血分数正常的非瓣膜性房颤患者（98例阵发性房颤患者和70例持续性房颤患者）和86例健康对照者。测量左心室区域和整体纵向及圆周应变。测量区域峰值纵向应变时间，并将所有12个节段的标准差（SDT-S）用作心室内不同步的指标。
与健康对照者相比，持续性房颤患者或阵发性房颤患者的整体纵向应变（GLS）（对照组为-18.71±3.00%，阵发性房颤组为-17.10±3.01%，持续性房颤组为-12.23±3.25%，P<0.05）和整体圆周应变（GCS）（对照组为-28.75±6.34%，阵发性房颤组为-24.43±6.86%，持续性房颤组为-18.46±6.42%，P<0.01）显著降低（P<0.05）。与阵发性房颤患者相比，持续性房颤患者的损害更严重（P<0.001）。持续性房颤患者和阵发性房颤患者均存在心室内不同步，且持续性房颤患者更严重（对照组为52±18毫秒，阵发性房颤组为61±17毫秒，持续性房颤组为70±28毫秒，P<0.05）。多因素回归分析显示房颤类型是GLS、GCS和心室内不同步的独立危险因素。
房颤类型不仅与左心室纵向和圆周力学受损有关，还与心室内机械不同步有关。与阵发性房颤患者相比，持续性房颤患者的收缩期力学和心室内不同步更差。
