摘要目的 探讨阵发性心房颤动(房颤)患者心房电机械延迟与短暂性脑缺血发作(TIA)/脑卒中的关系.方法 回顾性分析2015年10月至2018年5月于武汉大学人民医院心内科住院的阵发性房颤患者.根据患者有无TIA/脑卒中将患者分为TIA/脑卒中组(n=65)和无TIA/脑卒中组(n=157).使用超声心动图测量两组患者左心房内径、左心室舒张末期内径、左心室收缩末期内径,组织多普勒获取二尖瓣环外侧、二尖瓣环间隔侧和三尖瓣环右心室侧三个部位的电机械延迟时间(electrome-chanical delay time,EMD).EMD测量方法是从体表心电图P波起至舒张晚期波(A’)开始的时间间隔.二尖瓣环外侧和三尖瓣环右心室侧差值定义为心房间EMD;二尖瓣环间隔侧和三尖瓣环右心室侧差值定义为右心房内EMD;二尖瓣环间隔侧和二尖瓣环外侧差值定义为左心房内EMD.比较两组上述指标的差异,探讨各指标与TIA/脑卒中关系.结果 与无TIA/脑卒中组相比,TIA/脑卒中组左心房内径[(44.6±3.7) mm对(40.4±4.4) mm]、左心室舒张末期内径[(48.3±3.6) mm对(45.1±3.5) mm]、左心室收缩末期内径[(34.6±3.0) mm对(31.5±3.6) mm]、二尖瓣环外侧EMD[(130.0±2.7)ms对(115±6.5)ms]、心房间EMD[(89.1±8.4) ms对(70.0±7.9) ms]、左心房内EMD[(68.0±6.3)ms对(48.8±9.5) ms]均明显增高(P＜0.05);二尖瓣间隔侧EMD[(62.1±5.1) ms对(66.1±5.8) ms]、三尖瓣右心室侧EMD[(41.0±5.4) ms对(45.0±5.6) ms]降低(P＜0.05).两组患者左心室射血分数、右心房内EMD差异无统计学意义(P＞0.05).ROC曲线分析显示心房间EMD预测阵发性房颤患者TIA/脑卒中的最佳切点值为78.5 ms,ROC曲线下面积(AUC)为0.949,敏感度和特异度分别为89.2％和84.1％;左心房内EMD预测阵发性房颤患者TIA/脑卒中的最佳切点值为60.5 ms,AUC为0.957,敏感度和特异度分别为90.8％和87.3％.结论 与CHA2DS2-VASc评分一样,阵发性房颤患者心房间EMD和左心房内EMD的延长与脑卒中/TIA有关,评估这些参数可能有助于识别TIA/脑卒中的高风险患者.

abstractsObjective This study was to investigate the relationship between atrial electromechanical delay and transient ischemic attack (TIA) / stroke in patients with paroxysmal atrial fibrillation (PAF).Methods We selected the patients diagnosed with PAF in Renmin Hospital of Wahan University from October 2015 to May 2018.The patients were divided into TIA/stroke group(n =65) and no TIA/stroke group(n =157) according to whether the patients had TIA/stroke or not.Echocardiography was used to measure the left atrial diameter,left ventricular end-diastolic diameter,and left ventricular end-systolic diameter in both groups.Tissue Doppler was used to measure electromechanical delay time(EMD) at the lateral mitral annulus,septal mitral annulus and the tricuspid annulus.EMD was the time interval from the onset of the P wave to the beginning of the late diastolic A'wave.Interatrial EMD was the difference between PA'lateral and PA'tricuspid.Intra-right atrial EMD was the difference between PA'septal and PA'tricuspid.Intra-left atrial EMD was the difference between PA'septal and PA'lateral.The differences between the two groups were compared and the relationship between each index and TIA/stroke was explored.Results Compared with the TIA/stroke-free group,the left atrial diameter [(44.6±3.7) mm vs.(40.4±4.4) mm],left ventricular end-diastolic diameter[(48.3±3.6) mm vs.(45.1 ±3.5) mm],and left ventricular end-systolic diameter[(34.6±3.0) mm vs.(31.5±3.6) mm],mitral annulus EMD[(130.0±2.7) ms vs.(115±6.5) ms],interatrial EMD [(89.1±8.4) ms vs.(70.0±7.9) ms],left atrial EMD[(68.0±6.3) ms vs.(48.8±9.5) ms] in the TIA/stroke group were increased significantly (P＜0.05).The PA'septal[(62.1±5.1) ms vs.(66.1±5.8) ms] and PA'tricuspid [(41.0±5.4) ms vs.(45.0±5.6)ms] in the TIA/stroke group were lower than that in no TIA/stroke group(P＜0.05).There were no significant differences in cardiac ejection fraction and intra-right atrial EMD between the two groups (P＞0.05).The optimal cutoff for interatrial EMD to predict TIA/stroke in paroxysmal atrial fibrillation was 78.5 ms(sensitivity,89.2％;specificity,84.1％).The optimal cutoff for intra-left atrial EMD to predict TIA/stroke in PAF was 60.5 ms (sensitivity 90.8％;specificity 87.3％).Conclusion As with the CHA2DS2-VASc score,the extension of interatrial EMD and the intra-left atrial EMD in patients with PAF is associated with TIA/stroke.The assessment of this parameter in patients with PAF may contribute to the identification of high-risk patients with the TIA/stroke.