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目的探讨心房颤动(房颤)患者左心房自发超声显影(SEC)的超声学机制。方法经胸或经食管超声心动图分别测定44例房颤患者左心功能、形态学参数、左心耳和左上肺静脉血流速度,背向散射积分定量测量左心房SEC,共线性分析筛选独立的血流速度参数,后者与显著性形态学指标行多因素分析。结果与左心房SEC显著性相关的有左心房内径、左心耳入口内径、左心耳排空/充盈血流速度峰值、积分(Vi)和充盈血流速度平均值(RVm)、左上肺静脉血流速度S/D波峰值、S波积分(PVS-VTI)和D波平均值(PVD-M)(P<0.05~0.01)。共线性分析显示,RVm、RVi、PVS-VTI和PVD-M为独立、代表性血流速度指标。多因素分析显示,RVm和PVD-M为左心房SEC的独立预测因子(P<0.05)。结论左心耳充盈顺应性降低和跨二尖瓣血流的阻挡为左心房SEC形成的主要超声学机制,共线性分析为研究血流动力学和左心房SEC之间相互关系的有效方法。
Objective To investigate the ultrasound mechanism of left atrium spontaneous ultrasonography (SEC) in patients with atrial fibrillation (AF). Methods The transthoracic or transesophageal echocardiography was used to measure left ventricular function, morphological parameters, left atrial appendage and left upper pulmonary vein velocity in 44 patients with atrial fibrillation, Flow velocity parameters, the latter with significant morphological indicators of multi-factor analysis. Results Left atrial appendage, left atrial appendage, left atrial appendage / peak filling velocity, Vi and RVm, left upper pulmonary venous flow velocity S / D peak, S-wave integral (PVS-VTI) and D-wave mean (PVD-M) (P <0.05-0.01). Collinearity analysis showed that RVm, RVi, PVS-VTI and PVD-M were independent and representative indicators of blood flow velocity. Multivariate analysis showed that RVm and PVD-M were independent predictors of left atrial septum (P <0.05). Conclusions The decrease in the filling compliance of the left atrial appendage and the blockade of the cross-flow of the mitral valve are the major ultrasound mechanisms for the formation of left atrium SEC. Co-linear analysis is an effective method to study the relationship between hemodynamics and left atrial septum.