Ito T, Suwa M, Otake Y, Kobashi A, Hirota Y, Ando H, Kawamura K
Department of Internal Medicine, Osaka Medical College, Takatsuki City, Japan.
Am Heart J. 1998 Jun;135(6 Pt 1):1020-6. doi: 10.1016/s0002-8703(98)70067-5.
Although several flow patterns in the left atrial appendage have been described, mechanical determinants of its function have not been elucidated in human beings. We attempted to investigate changes in left atrial appendage function after cardioversion of atrial fibrillation and examine the potential relation between appendage function and left atrial mechanical function. Twenty patients without mitral valvular disease underwent transesophageal and transthoracic echocardiography at 24 hours and 1 week after cardioversion of atrial fibrillation. Left atrial appendage function was assessed by the pulsed Doppler measurements of left atrial appendage emptying and filling velocities corresponding to early and late ventricular diastole, respectively. Left atrial mechanical function was evaluated by the transmitral A-wave velocity, percent atrial contribution of the total left ventricular filling (percent atrial filling), and the pulmonary venous A-wave velocity. Left ventricular function was also estimated with conventional M-mode echocardiography. The late appendage emptying and filling velocities markedly increased during 1 week after cardioversion (p < 0.0001, respectively). This finding was associated with an increase in left atrial mechanical function. Changes in the late emptying and filling velocities significantly correlated with changes in the transmitral A-wave velocity (r = 0.59, p < 0.01), percent atrial filling (r = 0.61, p < 0.005), and the pulmonary venous A-wave velocity (r = 0.56, p < 0.05). In contrast, little change was observed in the early emptying and filling velocities. There was no relation between the indexes of left ventricular function and those of appendage function. In conclusion, unless there was an alteration of the loading conditions, left atrial appendage function improved over several days after cardioversion, and its function was related to left atrial mechanical function.
尽管已经描述了左心耳的几种血流模式，但尚未阐明其在人体中的功能机械决定因素。我们试图研究房颤复律后左心耳功能的变化，并探讨心耳功能与左心房机械功能之间的潜在关系。20例无二尖瓣疾病的患者在房颤复律后24小时和1周接受经食管和经胸超声心动图检查。通过分别对应于心室舒张早期和晚期的左心耳排空和充盈速度的脉冲多普勒测量来评估左心耳功能。通过二尖瓣A波速度、左心室总充盈的心房贡献率（心房充盈百分比）和肺静脉A波速度来评估左心房机械功能。还采用传统M型超声心动图评估左心室功能。复律后1周内，心耳晚期排空和充盈速度显著增加（分别为p < 0.0001）。这一发现与左心房机械功能的增加有关。晚期排空和充盈速度的变化与二尖瓣A波速度的变化显著相关（r = 0.59，p < 0.01）、心房充盈百分比（r = 0.61，p < 0.005）和肺静脉A波速度（r = 0.56，p < 0.05）。相比之下，早期排空和充盈速度几乎没有变化。左心室功能指标与心耳功能指标之间没有关系。总之，除非负荷条件发生改变，房颤复律后数天内左心耳功能会改善，且其功能与左心房机械功能相关。
