摘要: |
目的 应用二维斑点追踪技术测量非瓣膜性心房颤动(以下简称房颤)患者左房及左心耳应变,探讨其预测脑卒中的临床价值。方法 收集80例非瓣膜性房颤患者,据脑卒中病史分为卒中组(n=38)和非卒中组(n=42),均行经食管及经胸超声心动图检查,经常规测量及软件分析得到左房内径、左房容积指数、左房射血分数、左房应变、左心耳充盈排空速度、左心耳射血分数、左心耳应变等超声指标,比较两组上述参数的差异。采用多元Logistic回归分析非瓣膜性房颤患者发生脑卒中的影响因素;绘制受试者工作特征(ROC)曲线分析左房及左心耳应变对脑卒中的预测效能。结果 与非卒中组比较,卒中组左房射血分数、左心耳射血分数、左房储备期应变、左心耳排空及充盈速度、左心耳应变均减低,差异均有统计学意义(均P<0.05)。Logistic回归分析显示,左房储备期应变[OR=0.790(95%可信区间:0.678~0.920)]、左心耳应变[OR=0.727(95%可信区间:0.575~0.919)]均为非瓣膜性房颤患者发生脑卒中的独立预测因子(均P<0.05)。ROC曲线分析显示,左房储备期应变预测非瓣膜性房颤患者发生脑卒中的截断值为≤16.96%,曲线下面积为0.766,灵敏度为72.5%,特异度为75.0%;左心耳应变预测非瓣膜性房颤患者发生脑卒中的截断值为≤-6.88%,曲线下面积为0.753,灵敏度为52.5%,特异度为90.0%。结论 左房储备期应变、左心耳应变减低是非瓣膜性房颤患者发生脑卒中的独立预测因子,能早期、有效地预测脑卒中的发生。 |
关键词: 左心耳 左房 斑点追踪 非瓣膜性房颤 经胸、经食管超声 |
DOI: |
投稿时间:2023-02-28修订日期:2023-09-08 |
基金项目:宁夏回族自治区自然科学基金(2022AAC03603); |
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Predictive value of left atrium and left atrial appendage strain in stroke patients with non-valvular atrial fibrillation |
WANG Ting-ting,HUANG Xuan,PAN Lu,YE Jing-jing,ZHOU Li |
(Department in Functional Examination Department of Heart Center,General Hospital of Ningxia Medical University) |
Abstract: |
Objective To evaluate the clinical value of left atrial(LA)and left atrial appendicular(LAA)strain in stroke prediction of patients with nonvalvular atrial fibrillation (NVAF) by using two-dimensional speckle tracking technique(2D-STE). Methods Collecting 80 patients with nonvalvular atrial fibrillation, TTE and TEE was performed in all patients. Through routine measurement and software analysis. LAD,LAVI,LAEF,LAAEV.LAAFV,LAAEF were obtained. The LASr,LAScd and LAAS were measured by 2D-STE.The TTE images of LA and the TEE images of LAA were acquired for data analysis;Comparing the difference between the two sets of the above parameters. Multivariate Logistic regression was used to analyze the influencing factors of stroke in patients with NVAF. Receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of left atrial and left atrial auricular strain in stroke. Results Left atrial ejection fraction(LAEF),Left atrial strain reservoir function(LASr),left atrial ejection fraction(LAEF),Left atrial appendage emptying velocity(LAAEV) and Left atrial appendage filling velocity(LAAFV) and The left atrial appendage strain(LAAS)in the stroke group were significantly lower than those in the non-stroke group(P<0.05);The logistic regression analysis,LAAS[OR=0.790(95,%CI:0.678~0.90)],LASr[OR=0.727(95%CI:0.575~0.919)],LAAS and LASr were independent predictors of stroke in patients with NVAF(P<0.05);LASr:cut-off value≤16.96%,sensitivity 72.5%,specificity 75%,AUC 0.766;LAAS ;cut-off value≤-6.88%,sensitivity 52.5%,specificity 90.0%,AUC 0.753; Conclusion LASr and LAAS reduction are independent predictors of stroke in patients with NVAF, which can predict the occurrence of stroke early and effectively. |
Key words: Transthoracic and transesophageal echocardiography Two-dimensional speckle tracking imaging Left atrial Left atrial appendage Nonvalvular atrial fibrillation |