Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation
Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation
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DOI：
10.1536/ihj.15-345
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发表时间：
2016-03-01
影响因子：
1.5
通讯作者：
Yamashita, Takeshi
中科院分区：
文献类型：
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作者：
Watanabe, Atai;Suzuki, Shinya;Yamashita, Takeshi
房颤（AF）与卒中和其他血栓栓塞事件的风险增加相关。左心房（LA）血栓形成与LA功能障碍密切相关，特别是房颤患者的左心耳血流速度（LAA-FV）降低。我们使用经胸超声心动图（TTE）无创获得的参数估计阵发性房颤患者的LAA-FV。对190例经食管超声心动图显示窦性心律的非瓣膜性阵发性房颤患者的超声心动图和临床参数进行了评估（TEE）和TTE.LAA-FV（60 +/-22 cm/s）与ECG上P波起始时间和FIB上二尖瓣血流A波起始时间之间的时间间隔显著相关。（PA与LA的相关系数为-0.32; P < 0.001），LA维度组织多普勒超声心动图室间隔a'流速（LAD，-0.31; P < 0.001）（TDI，0.35; P < 0.001），E/e'比值（-0.28，P < 0.001），E流速二尖瓣血流E/A比值（-0.18，P = 0.02）、CHA 2DS 2-VASc评分（-0.15，P = 0.04）和血浆BNP水平（-0.32，P = 0.002）。多因素分析显示，PA-100（标准化偏回归系数，-0.17; P = 0.03），a'速度（0.24，P = 0.004）和LAD（-0.20，P = 0.01）是LAA-FV的独立预测因子复相关系数R = 0.44;心房重构参数，即α '流速降低，LAD增加，窦性心律时的PA-FV可能是非瓣膜性PAR患者左心房瘀血的有用预测指标。
Atrial fibrillation (AF) is associated with an increased risk of stroke and other thromboembolic events. Left atrial (LA) thrombus formation is closely related to LA dysfunction, particularly to decreased LA appendage flow velocity (LAA-FV) in patients with AF. We estimated LAA-FV using parameters noninvasively obtained by transthoracic echocardiography (TTE) in patients with paroxysmal AF.Echocardiographic and clinical parameters were assessed in 190 patients with nonvalvular paroxysmal AF showing sinus heart rhythm during transesophageal echocardiography (TEE) and TTE.LAA-FV (60 +/- 22 cm/s) significantly correlated with the time interval between the initiation of the P-wave on ECG and that of the A-wave of transmitral flow on fib (PA-TMF, correlation coefficient, -0.32; P < 0.001), LA dimension (LAD, -0.31; P < 0.001), septal a' velocity of tissue Doppler imaging (TDI, 0.35; P < 0.001), E/e' ratio (-0.28, P < 0.001), E velocity of transmitral flow (-0.20, P = 0.008), E/A ratio of transmitral flow (-0.18, P = 0.02), CHA2DS2-VASc score (-0.15, P = 0.04), and BNP plasma level (-0.32, P = 0.002). Multivariate analysis revealed that PA-TMF (standardized partial regression coefficient, -0.17; P = 0.03), a' velocity (0.24, P = 0.004), and LAD (-0.20, P = 0.01) were independent predictors of LAA-FV (multiple correlation coefficient R, 0.44; P < 0.001).Parameters of atrial remodeling, ie, decreased a' velocity, increased LAD, and PA-TMF during sinus rhythm may be useful predictors of LA blood stasis in patients with nonvalvular PAR LAA-FV can be estimated using these fib parameters instead of TEE.