摘要
目的:评估非梗阻性肥厚型心肌病(NOHCM)合并持续性房颤(perAF)患者在接受导管消融后左心房结构和功能的重构,并探究超声心动图参数对术后房颤复发的预测价值。方法:连续性纳入2023年1月-2024年12月在中国医学科学院阜外医院确诊的有完整临床资料和完整、清晰超声心动图影像资料的20例NOHCM合并perAF并接受导管消融的患者,根据随访期间是否复发分为合并复发组(n=11)和无复发组(n=9)。使用单拍实时全容积三维超声心动图测量左心房容积和左心房射血分数,采用二维斑点追踪技术测量左心房应变,并测量其他常规参数。比较术前及术后左心房结构及功能的差异,并采用Cox回归分析该类患者房颤复发的风险因子。结果:平均随访时间为10.4±6.4月,随访期间11例(55%)复发房颤/房扑。对于全组患者,术后3月左心房前后径(LAD)[(47.20±3.64)mm vs.(49.55±3.80)mm,P<0.05]、双平面左心房容积指数(LAVi)[(54.84±13.01)mL/m^(2)vs.(61.33±14.38)mL/m^(2),P<0.05]、三维LAVi[(60.63±12.90)mL/m^(2)vs.(70.32±14.20)mL/m^(2),P<0.05]均较术前减小,左心房射血分数(LAEF)较术前增加(25.15%±8.49%vs.18.50%±5.42%,P<0.05),无复发组患者的左心房减小的程度及左心房射血分数增加程度较复发组大,后续随访期间呈相同趋势。全组患者术前均丧失左心房收缩应变,术后获得一定程度恢复。全组患者术后3个月左心房存储应变(LASr)(10.17%±3.79%vs.6.01%±2.80%,P<0.05)较术前增加,复发组的术前及术后LASr均较无复发组低,后续随访期间呈相同趋势。多因素Cox回归分析显示,术前LASr[HR:0.629(0.406~0.972),P=0.037]及三维LAVi[HR:1.061(1.018~1.202),P=0.047]为房颤复发的独立预测因子。结论:NOHCM合并perAF患者接受导管消融术后左心房结构和功能显著改善。术前LASr及三维LAVi有可能可以成为预测该类患者导管消融后复发的潜在影像指标。
Objective:To evaluate left atrial(LA)structural and functional remodeling after catheter ablation in patients with non-obstructive hypertrophic cardiomyopathy(NOHCM)complicated by persistent atrial fibrillation(perAF),and to explore the predictive value of echocardiographic parameters for post-ablation AF recurrence.Methods:A total of 20 consecutive patients with NOHCM complicated by perAF who underwent catheter ablation at Fuwai Hospital,Chinese Academy of Medical Sciences from January 2023 to December 2024 with complete clinical data and high-quality echocardiographic imaging data were enrolled.Based on whether AF recurred during follow-up,patients were divided into the recurrence group(n=11)and non-recurrence group(n=9).Single-beat real-time full-volume three-dimensional(3D)echocardiography was used to measure LA volume and LA ejection fraction(LAEF).Two-dimensional speckle-tracking technology was applied to assess LA strain,and other conventional parameters were also measured.Differences in LA structure and function before and after ablation were compared,and Cox regression analysis was performed to identify risk factors for AF recurrence.Results:The mean follow-up duration was 10.4±6.4 months,during which 11 patients(55%)experienced recurrence of AF/atrial flutter.At 3 months post-ablation,the entire cohort showed significant reductions in LA diameter(LAD)[(47.20±3.64)mm vs.(49.55±3.80)mm,P<0.05],biplane LA volume index(LAVi)[(54.84±13.01)mL/m^(2) vs.(61.33±14.38)mL/m^(2),P<0.05],and 3D LAVi[(60.63±12.90)mL/m^(2) vs.(70.32±14.20)mL/m^(2),P<0.05],along with increased LAEF(25.15%±8.49%vs.18.50%±5.42%,P<0.05).The magnitude of left atrial size reduction and LAEF improvement was greater in the non-recurrence group than in the recurrence group,with the same trend maintained during subsequent follow-up.Preoperatively,all patients had lost LA contractile strain,which partially recovered post-ablation.LA reservoir strain(LASr)significantly improved at 3 months(10.17%±3.79%vs.6.01%±2.80%,P<0.05).Both preoperative and postoperative LASr were lower in the recurrence group than in the non-recurrence group,with the consistent trend observed during further follow-up.Multivariate Cox regression analysis revealed that preoperative LASr[HR:0.629(0.406~0.972),P=0.037]and 3D LAVi[HR:1.061(1.018~1.202),P=0.047]were independent predictors of AF recurrence.Conclusion:In patients with NOHCM complicated by perAF,LA structure and function improve significantly after catheter ablation.Preoperative LASr and 3D LAVi may serve as potential imaging indicators for predicting recurrence after catheter ablation in this patient population.
作者
杨盼
唐亚捷
肖明虎
姚焰
丁立刚
朱振辉
YANG Pan;TANG Ya-jie;XIAO Ming-hu(Ultrasound Department,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)
出处
《放射学实践》
北大核心
2025年第11期1363-1369,共7页
Radiologic Practice
基金
中国医学科学院阜外医院特色学科发展项目基金(2022-FWTS09)。
关键词
非梗阻性肥厚型心肌病
持续性房颤
导管消融
左心房
Non-obstructive hypertrophic cardiomyopathy
Persistent atrial fibrillation
Catheter ablation
Left atrium
