Effect of Paroxysmal Atrial Fibrillation and the Clinical Concomitant on Left Cardiac Chambers
|School||Tianjin Medical University|
|Keywords||Ultrasound echocardiography Tissue Doppler Strain ( rate ) imaging Paroxysmal Atrial fibrillation Clinical complications Left heart|
Objective: To explore the traditional two-dimensional and tissue Doppler ultrasound imaging technology: (1) paroxysmal atrial fibrillation (PAF) in / clinical complications of left heart (left ventricular function and structure of the left atrium, left atrial overall and separate effects of local functions) to to identify PAF patients with a history of left ventricular characteristics which contribute to the early diagnosis of AF; (2) PAF and clinical complications of left heart interaction; statistical analysis: (3) organization Doppler strain, strain rate peak left atrial size and the overall correlation function; (4) the observer measurement data consistency. Method: in May 2010 to January 2011, according to certain standards consecutive patients underwent echocardiography subjects in 80 cases, the normal control group, 11 cases, 20 cases of PAF group, clinical complications group 29 cases and PAF group with clinical complications of 20 cases. Probe frequency applications produced by the U.S. General 1.7 ~ 3.4MHz Vivid 7 color Doppler ultrasonic diagnostic apparatus of all inductees traditional two-dimensional and tissue Doppler echocardiography measurements before and after left atrial diameter (LAD) Left ventricular ejection fraction (LVEF), left atrial volume, minimum volume and the P volume (LAVmax, LAVmin and the LAVpre), peak mitral early diastolic and atrial systolic speed (E, A), velocity time integral (VTle, VTla), E peak deceleration time (DT); left atrial volume index (LAVI) According to the formula, the left atrial expansion index (LAEI), left atrial passive emptying fraction (LAPEF), left atrial active emptying fraction ( LAAEF) and atrial filling fraction (LAFF). Measurement the mitral side of the ring and spacer ring systolic and early diastolic and atrial systolic peak velocity (Sa, Ea and Aa), atrial electrical impulse conduction time (P-A), atrial contraction peak time (tA) the side wall of the left atrium, atrial septal, inferior, and posterior wall of the middle segment myocardial systolic peak early diastolic and atrial systolic strain (Stotle, S and S-) and strain rate peak (SRs, SRe SRa); according to the formula calculate the E / Ea tAc average strain and strain rate peak (MS, MSR). Application SPSS16.0 statistical software to meet the test premise into a group designed t-test, rank sum test, factorial design quantitative data covariance above parameters of observed differences between the groups, which found that the PAF clinical complications (including the impact on the structure and function of the left ventricular function, left atrial separate effects, the main effects and interaction effects). Spearman rank correlation analysis of tissue Doppler strain and peak strain rate and left atrial size and the overall correlation function. Tissue Doppler velocities, strain and strain rate parameters for the Bland --- Altman graph analysis intraobserver measurement consistency. Results: 1. Paroxysmal atrial fibrillation group P - A value higher than the normal control group; DT, tA, tAc, LVEF, L-S, and the L-Stotle value is lower than the normal control group, the difference was statistically significant. Paroxysmal atrial fibrillation associated with a the clinical complications group of L-Sa, P-value is higher than A clinical comorbidity group; S-Aa, L-the SRs, L-SRe value lower than clinical comorbidity group, the difference was statistically significance. 3 under conditions exclude the sex, age, BMI, BSA, blood pressure and heart rate effects of ultrasound parameters, negative to the L-Stotle, L-SRs, P-S, MS negative indicator of P-A as effect, PAF The main effect was statistically significant; interaction effects between L-Ea and L-Sa effect indicators, PAF and clinical complications. 4 between the L-SRa of with LAD, LAVImax, LAVIpre LAVImin, between L-SRe with LAVImax, MSRa with LAD, LAVImax between a weak positive correlation, ie With the L-SRa, L-SRe and MSRa increase (the absolute value of the strain rate decreases) LAVI (?) had large. The MSRs LAD, LAVImax weak negative correlation. Individually analyzed the Bland-Altman plots revealed two measurements of the same observer mitral annular velocity peak good agreement; side wall of the middle of the left atrial posterior wall of the middle of the strain peak and peak strain rate is less consistently , but the difference between the mean of the two measurements and theoretical difference 0 is very close. Conclusion: 1.PAF the separate effect mainly in the middle of systolic and early diastolic strain and strain rate values ??to reduce the left atrial electrical impulse conduction time, which is the characteristics of the patients with a history of PAF, the crowd left atrial sidewall The focus of follow-up help in the early diagnosis and treatment of paroxysmal atrial fibrillation. Left ventricular diastolic and systolic dysfunction, left atrial atrial fibrillation increased susceptibility to ensure that the amount of compensatory left ventricular filling process. From the point of view of the findings, atrial remodeling and atrial fibrillation, left ventricular diastolic dysfunction and atrial fibrillation between is likely to be a causal relationship to each other, to be further studied. 4 as the maximum left atrial volume index of regional myocardial left atrial reservoir, pipeline and pump function decline increases (both weak), and little change in the overall function of the left atrium. Two measurements of the same observer the mitral side of the ring speed peak better consistency the middle of the side wall of the left atrium, strain and strain rate of the posterior wall of the middle peak is less consistently (but small systematic error).