Clinical significance of transesophageal echocardiography in evaluating the volume and function of left atrial appendage in patients with non-valvular atrial fibrillation
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摘要:
目的 探究经食道超声心动图（TEE）评估非瓣膜性房颤患者左心耳容积和功能的临床价值及意义。 方法 选取2016年8月~2020年8月于成都市新都区人民医院行TEE检查且确诊为非瓣膜性房颤的患者138例为房颤组，另选取同期因怀疑为其他心血管疾病而接受TEE检查的对象47例作为对照组。TEE多切面观察两组患者的左心耳超声图像，应用Simpson双平面法获取左心耳容积参数，所有对象均通过经胸超声心动图采集左房三维容积图像，并导入Qlab9.0分析软件，获取左房的容积及变化参数。比较两组患者的左心房、左心耳容积参数和血流动力学参数，分析不同左心耳功能患者的血栓形成及自发显影情况。 结果 房颤组患者的左房射血分数、左心耳射血分数、心耳容积变化率、左心耳最大排空速度和体表面积标化的左心耳排空指数均小于对照组（P < 0.05），左房最大容积、左房最小容积、左心耳最大容积和左心耳最小容积均大于对照组（P < 0.05）。房颤组中，左心耳功能正常89例（64.49%），左心耳功能轻度下降31例（22.46%），左心耳功能中重度下降18例（13.04%），不同左心耳功能状态患者的血栓形成和自发显影情况比较，差异有统计学意义（P < 0.05），且功能中重度下降患者的血栓形成率高于轻度下降和正常患者（P < 0.05）；功能中重度下降患者的自发显影严重程度高于正常患者（P < 0.05）。 结论 TEE在评估非瓣膜性房颤患者左心耳容积和功能中具有良好的临床价值，患者左心耳功能下降水平越高，发生血栓形成和自发显影风险越大。 Abstract:Objective To investigate the clinical value and significance of transesophageal echocardiography (TEE) in evaluating the volume and function of left atrial appendage in patients with non- valvular atrial fibrillation. Methods A total of 138 patients with non-valvular atrial fibrillation who underwent TEE in Xindu District People's Hospital, Chengdu from August 2016 to August 2020 were defined as the atrial fibrillation group. Forty-seven individuals who underwent TEE during the same period because of other cardiovascular diseases were defined as the control group. Multiplane TEE was used to observe left atrial appendage. The volume parameters of left atrial appendage were obtained by Simpson's biplane method. Three-dimensional left atrial volume images of all subjects were collected by transthoracic echocardiography, and imported into Qlab9.0 software to obtain left atrial volume and change parameters. The volume parameters and hemodynamic parameters of left atrium and left atrial appendage in the two groups were comparatively analyzed. The thrombosis and spontaneous contrast in patients with different left atrial appendage function were analyzed. Results Left atrial ejection fraction, left atrial appendage ejection fraction, volume change rate of left atrial appendage, emptying maximum speed of left atrial appendage and left atrial appendage emptying index standardized by body surface area in the atrial fibrillation group were lower than those in the control group. The maximum left atrial volume, minimum left atrial volume, maximum volume of left atrial appendage and minimum volume of left atrial appendage were greater than those in the control group (P < 0.05). In the atrial fibrillation group, there were 89 cases (64.49%) with normal left atrial appendage function, 31 cases (22.46%) with slight decline in left atrial appendage function, and 18 cases (13.04%) with moderate to severe decline in left atrial appendage function. The status of thrombosis and spontaneous contrast showed statistically significant differences in patients with different status of left atrial appendage function (P < 0.05). The thrombosis rate in patients with moderate to severe decline was higher than that in patients with mild decline or patients with normal function (P < 0.05). The severity of spontaneous contrast in patients with moderate to severe decline was higher than that in patients with normal function (P < 0.05). Conclusion TEE is helpful for evaluating the volume and function of left atrial appendage in patients with non-valvular atrial fibrillation. The greater the left atrial appendage function decline, the higher the risk of thrombosis and spontaneous contrast. -
图 1 经胸超声心动图三维容积扫描获取左心耳三维容积参数
A: 左房最小容积; B: 左房最大容积; C: 左房容积变化曲线.
Figure 1. Three-dimensional volume parameters of left atrial appendage obtained by TTE three-dimensional volume scanning.
图 2 Simpson双平面法获取左心耳功能参数
A: 左心耳容积; B: 左心耳最大排空速度.
Figure 2. Left atrial appendage function parameters obtained by Simpson dual-pane method.
表 1 两组患者左房容积指标比较
Table 1. Comparison of left atrial volume indicators between the two groups (Mean±SD)
组别 LAEF（%） LAVmax（mL） LAVmin（mL） 房颤组（n=138） 42.06±10.93 55.32±13.65 23.83±4.57 对照组（n=47） 67.73±8.37 37.85±11.34 18.76±3.38 t 15.263 7.892 6.978 P ＜.001 ＜0.001 ＜0.001 LAEF: 左房射血分数; LAVmax: 左房最大容积; LAVmin: 左房最小容积. 
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表 2 两组患者左心耳容积参数比较
Table 2. Comparison of left atrial appendage volume parameters between two groups(Mean±SD)
组别 LAAEF（%） LAAVmax（mL） LAAVmin（mL） 房颤组（n=138） 36.28±4.73 8.67±2.28 5.52±1.02 对照组（n=47） 80.56±8.21 5.41±1.47 1.05±0.31 t 45.170 9.166 29.535 P ＜0.001 ＜0.001 ＜0.001 LAAVmax: 左心耳最大容积; LAAVmin: 左心耳最小容积; LAAEF: 左心耳射血分数.
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表 3 两组患者左心耳血流动力学参数比较
Table 3. Comparison of hemodynamic parameters of left atrial appendage between two groups (Mean±SD)
组别 LAA-VCR（%） LAA-PEV（cm/s） LAAEI（%） 房颤组（n=138） 50.38±9.67 81.65±15.22 49.47±15.31 对照组（n=47） 57.59±11.46 94.63±18.75 67.24±13.48 t 4.206 4.750 7.075 P ＜0.001 ＜0.001 ＜0.001 LAA-VCR: 心耳容积变化率; LAA-PEV: 左心耳最大排空速度; LAAEI: 左心耳排空指数.
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表 4 不同左心耳功能状态患者血栓形成及自发显影情况比较
Table 4. Comparison of the status of thrombosis and spontaneous contrast between patients with different left atrial appendage functional status [n(%)]
组别 血栓形成 自发显影 无自发性显影 轻度自发性显影 重度自发性显影 功能正常（n=89） 4（4.49） 80（89.89） 8（8.99） 1（1.12） 功能轻度下降（n=31） 7（22.58） 21（67.74） 6（19.35） 4（12.90） 功能中重度下降（n=18） 7（38.89） 9（50.00） 3（16.67） 6（33.33） χ2 18.822 26.737 P ＜0.001 ＜0.001
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