2022 年第 11 期 第 17 卷

肺静脉超声参数与心房颤动患者胺碘酮药物转复效果的相关性

Correlation between pulmonary vein ultrasound parameters and the effect of amiodarone conversion in patients with atrial fibrillation

作者：唐艳云陈燕红张龙秦青秀

英文作者：Tang Yanyun Chen Yanhong Zhang Long Qin Qingxiu

单位：中国人民解放军联勤保障部队第九〇九医院厦门大学附属东南医院超声科，漳州363000

英文单位：Department of Ultrasonography the 909th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army the Affiliated Southeast Hospital of Xiamen University Zhangzhou 363000 China

关键词：心房颤动；肺静脉超声；胺碘酮；转复效果

英文关键词：Atrialfibrillation;Pulmonaryveinultrasound;Amiodarone;Conversioneffect

• 摘要：

• 目的 探讨肺静脉超声参数与心房颤动患者胺碘酮药物转复效果的相关性。方法 前瞻性选取中国人民解放军联勤保障部队第九〇九医院2021年1—11月收治的103例心房颤动患者为研究对象。所有患者均接受肺静脉超声检查及胺碘酮治疗，将胺碘酮治疗后恢复窦性心律的患者作为A组，胺碘酮治疗后未恢复窦性心律需进行电复律的患者作为B组。比较2组患者肺静脉超声参数，采用多因素Logistic回归方法分析心房颤动患者胺碘酮药物转复失败的影响因素，采用受试者工作特征（ROC）曲线分析各因素预测心房颤动患者胺碘酮药物转复效果的效能。结果 103例心房颤动患者中59例经胺碘酮治疗后恢复窦性心律，为A组，余44例为B组。A组患者室间隔厚度、左心房容积、左心房容积指数、二尖瓣E波峰值速度小于B组［（0.92±0.11）cm比（1.00±0.13）cm、（31±9）cm3比（39±9）cm3、（20±4）cm3/m2比（22±3）cm3/m2、（64±4）cm/s比（69±9）cm/s］，等容舒张时间（IVRT）、早期二尖瓣血流减速时间（DT）、肺静脉S波峰值速度、肺静脉D波峰值速度长于/大于B组［（51±6）ms比（46±6）ms、（57±3）ms比（51±4）ms、（49.6±4.3）cm/s比（40.8±2.7）cm/s、（57.7±4.5）cm/s比（51.9±2.0）cm/s］，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，短IVRT（比值比=0.724）、短DT（比值比=0.481）、低肺静脉S波峰值速度（比值比=0.701）、低肺静脉D波峰值速度（比值比=0.486）是心房颤动患者药物转复失败的独立危险因素（均P＜0.05）。ROC曲线分析结果显示，IVRT、DT、肺静脉S波峰值速度、肺静脉D波峰值速度低于截断值可预测心房颤动患者药物转复失败，曲线下面积分别为0.730、0.844、0.950、0.885。结论 肺静脉超声参数IVRT、DT、肺静脉S波峰值速度、肺静脉D波峰值速度与心房颤动患者药物转复效果相关，可作为心房颤动患者药物转复效果的预测因子。

• Objective To investigate the correlation between pulmonary vein ultrasound parameters and the effect of amiodarone conversion in patients with atrial fibrillation. Methods Totally 103 patients with atrial fibrillation who were admitted to the 909th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army from January to November 2021 were prospectively selected as the research objects. All patients received pulmonary vein ultrasound detection and amiodarone treatment. The patients who recovered to sinus rhythm after amiodarone treatment were selected as group A, while the patients who did not restore sinus rhythm after amiodarone treatment and required electrical cardioversion were selected as group B. The pulmonary vein ultrasound parameters of the two groups were compared, and the multivariate Logistic regression method was used to analyze the influencing factors of amiodarone conversion failure in patients with atrial fibrillation. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of various factors to predict amiodarone conversion effect in patients with atrial fibrillation. Results Among those 103 patients, 59 patients recovered to sinus rhythm after treatment with amiodarone, divided into group A, and the remaining 44 patients were divided into group B. The inter-ventricular septum thickness, left atrial volume, left atrial volume index, and peak velocity of mitral valve E wave in group A were less than those in group B［（0.92±0.11）cm vs （1.00±0.13）cm, （31±9）cm3 vs （39±9）cm3, （20±4）cm3/m2 vs （22±3）cm3/m2, （64±4）cm/s vs （69±9）cm/s］, and the isovolumic relaxation time(IVRT), early transmitral flow deceleration time(DT), peak velocity of pulmonary vein S wave, and peak velocity of pulmonary vein D wave were longer/greater than those in group B［（51±6）ms vs （46±6）ms, （57±3）ms vs （51±4）ms, （49.6±4.3）cm/s vs （40.8±2.7）cm/s, （57.7±4.5）cm/s vs （51.9±2.0）cm/s］(all P＜0.05). Multivariate Logistic regression analysis showed that short IVRT ［odds ratio(OR)=0.724］, short DT (OR=0.481), low peak velocity of pulmonary vein S wave (OR=0.701), and low peak velocity of pulmonary vein D wave(OR=0.486) were independent risk factors for failure of drug conversion in patients with atrial fibrillation (all P＜0.05). ROC curve analysis showed that the areas under the curve of IVRT, DT, peak velocity of pulmonary vein S wave and peak velocity of pulmonary vein D wave (below the cutoff value) predicting the failure of drug conversion in patients with atrial fibrillation were 0.730, 0.844, 0.950 and 0.885 respectively. Conclusions Pulmonary vein ultrasound parameters IVRT, DT, peak velocity of pulmonary vein S wave, peak velocity of pulmonary vein D wave are significantly correlated with the effect of drug conversion in patients with atrial fibrillation. They can be used as the predictors of drug conversion effect.