摘要目的 采用双多普勒同步取样技术(双多普勒技术)评价阵发性心房颤动(房颤)患者心房内及心房间同步性,并探讨心房不同步评估阵发性房颤发生风险的价值.方法 选取29例阵发性房颤患者为房颤组,24例健康志愿者为对照组,采用双多普勒技术将两个取样容积分别置于二尖瓣环室间隔及侧壁位点、三尖瓣环室间隔及右室游离壁位点、二尖瓣环侧壁及三尖瓣环右室游离壁位点,同步获取两个位点心肌组织运动频谱a’波起点的时间差分别为T1、T2、T3,分别用以评估左房、右房、双房同步性,其值越大,表明同步性越差.比较房颤组与对照组心房内及心房间同步性,并以ROC曲线下面积获取预测阵发性房颤的最佳指标,联合该指标与左房容积指数(LAVI)预测阵发性房颤,并寻求其预测的截断值.结果 ①房颤组双房各径线、容积、容积指数、舒张早期二尖瓣口血流峰值速度(E)与瓣环室间隔位点速度(e')比值(E/e’)较对照组增大(P＜0.05),余指标差异无统计学意义(P＞0.05).②房颤组标化心率前后T1、T2、T3都较对照组显著增大(P＜0.01).标化T1预测阵发性房颤的曲线下面积最大.标化T1、LAVI及其联合预测阵发性房颤的曲线下面积分别为76.6％、84.1％、87.1％;联合标化T1≥29.55 ms与LAVI≥21.60 ml/m2预测阵发性房颤的敏感性、特异性最高,分别为82.8％、79.2％.③标化T1与年龄、左房前后径、右房容积指数、E/e'、LAVI呈正相关(P＜0.05).结论 阵发性房颤患者心房内及心房间不同步明显增加,左房不同步尤为明显,可为评估阵发性房颤发生风险提供有价值的信息.双多普勒技术有望成为一种准确评价阵发性房颤患者心房同步性并有效评估房颤发生风险的新方法.

abstractsObjective To evaluate intra-and interatrial synchronization in patients with paroxysmal atrial fibrillation (PAF) by dual gate Doppler and discuss the predictive value of atrial asynchrony for detecting PAF.Methods Twenty-nine patients with PAF as AF group and 24 healthy volunteers as control group underwent echocardiography.The time interval of the onset of a'wave between mitral annular septal and lateral site was T1 by dual gate Doppler,which was used to evaluate left atrial synchronization.The time intervals from the onset of a'wave at tricuspid annular right ventricular free wall site to a'wave at tricuspid annular septal site and mitral annular lateral site were T2 and T3,which were respectively used to evaluate right atrial and interatrial synchronization.The greater time interval predicted the worse synchronization.Compared these indexes between two groups,the most valuable index was obtained and combined with left atrial volume index (LAVI) to predict PAF,its optimal values were found out by ROC curve.Results ①There were no significant differences in many other basic indexes between two groups (P ＞0.05).However,compared with control group,the ratio of early diastolic transmitral flow velocity (E) and mitral annular velocity of septal site (e'),the diameters and volume indexes of atria were significantly increased in AF group.②T1,T2 and T3 (standardized before and after) increased significantly in AF group (P ＜0.01).Standardized T1 had the largest area under curve (AUC) for detecting PAF.The AUC of standardized T1 and LAVI were 76.6％ and 84.1％.Standardized T1 ≥29.55 ms and LAVI≥ 21.60 ml/m2 were combined for detecting PAF (sensitivity 82.8 ％,specificity 79.2％,AUC 87.1％).③ Standardized T1 was positively correlated with age,left atrial systolic diameter,LAVI,RAVI and E/e'(P＜ 0.05).Conclusions Patients with PAF have worse intra-and interatrial synchronization and left atrial asynchrony can provide predictive value for detecting PAF.Dual gate Doppler is expected to be a new technique for evaluating intra-and interatrial synchronization accurately and detecting the risk of AF.