Kawaji Tetsuma, Shiomi Hiroki, Bao Bingyuan, Hojo Shun, Tezuka Yuji, Yaku Hidenori, Nakatsuma Kenji, Matsuda Shintaro, Kaneda Kazuhisa, Kato Masashi, Yokomatsu Takafumi, Miki Shinji
Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Int J Cardiol. 2023 May 15;379:136-142. doi: 10.1016/j.ijcard.2023.03.021. Epub 2023 Mar 11.
Intracardiac dynamics during atrial fibrillation(AF) complicated by heart failure(HF) are not fully understood. The aim of this study was to evaluate the impact of intracardiac dynamics assessed by echo-vector flow mapping on AF complicated by HF.
We enrolled 76 AF patients receiving sinus restoration therapy and assessed energy loss(EL) by echo-vector flow mapping during both AF rhythm and sinus rhythm. Patients were divided into 2 groups according to serum NT-proBNP level: high NT-proBNP group(≥1800 pg/ml during AF rhythm: N = 19), and low NT-proBNP group(N = 57). Outcome measures were average ELs/stroke volume(SV) in left ventricle(LV) and left atrium(LA). Average EL/SVs during AF rhythm in the LV and LA were significantly larger in the high NT-proBNP group than the low NT-proBNP group(54.2 mE/m·L versus 41.2 mE/m·L, P = 0.02; 3.2 mE/m·L versus 1.9 mE/m·L, P = 0.01). The significantly larger EL/SV in the high NT-proBNP group was recorded for maximum EL/SVs. In patients with high NT-proBNP, large vortex formation with extreme EL was detected in the LV and LA during the diastolic phase. After sinus restoration, the average decrease of EL/SV in the LV and LA was larger in the high NT-proBNP group(-21.4 mE/m·L versus +2.6 mE/m·L, P = 0.04; -1.6 mE/m·L versus -0.3 mE/m·L, P = 0.02). Average EL/SV during sinus rhythm did not significantly differ between the high and low NT-proBNP groups in the LV and LA.
High EL during AF rhythm as intracardiac energy inefficiency was associated with high serum NT-proBNP levels and improved after sinus restoration.
心房颤动（AF）合并心力衰竭（HF）时的心内动力学尚未完全明确。本研究旨在评估经超声向量血流图评估的心内动力学对AF合并HF的影响。
我们纳入了76例接受窦性心律恢复治疗的AF患者，并在AF心律和窦性心律期间通过超声向量血流图评估能量损失（EL）。根据血清N末端B型利钠肽原（NT-proBNP）水平将患者分为两组：高NT-proBNP组（AF心律时≥1800 pg/ml：N = 19）和低NT-proBNP组（N = 57）。观察指标为左心室（LV）和左心房（LA）的平均EL/每搏输出量（SV）。高NT-proBNP组LV和LA在AF心律期间的平均EL/SV显著高于低NT-proBNP组（54.2 mE/m·L对41.2 mE/m·L，P = 0.02；3.2 mE/m·L对1.9 mE/m·L，P = 0.01）。高NT-proBNP组最大EL/SV时的EL/SV也显著更大。在高NT-proBNP患者中，舒张期LV和LA检测到伴有极高EL的大涡旋形成。窦性心律恢复后，高NT-proBNP组LV和LA的EL/SV平均下降幅度更大（-21.4 mE/m·L对+2.6 mE/m·L，P = 0.04；-1.6 mE/m·L对-0.3 mE/m·L，P = 0.02）。高、低NT-proBNP组LV和LA在窦性心律期间的平均EL/SV无显著差异。
AF心律期间作为心内能量低效的高EL与高血清NT-proBNP水平相关，且在窦性心律恢复后有所改善。
