Two-dimensional Speckle Tracking Technology Assessment Study On The Effect Of Minimally Invasive Treatment Of Atrial Fibrillation

PartⅠ Two-dimensional speckling tracking technologyassessment the left atrial function in normal personObjective Using speckling tracking imaging to evaluate the function of left atrial indifferent age groups of normal person. Summarizing the variation trend of left atrial strain ratewhich can be on behalf of the left atrial stored function, pipes function, and the auxiliarypump function. In order to the further study for the pathological left atrial function.Methods A total of90people (male53and female37, average age54.7±11.82) wereincluded in the present study who took the normal heart examination in Department ofUltrasound, Changhai Hospital during the Mar,2012to Mar,2013. The90persons weredivided into3groups: youth group(30persons, the age≤45), mid-age group(30persons,45＜age≤65), old-age group(30persons, the age＞65). All the observable receivedechocardiography. Record the left atrial and left ventricle ultrasonic measurement parameters,collected and saved a series of left atrial two-dimensional dynamic ultrasound images. Usingthe STI to analysis the images and establish the database. Analysis the left atrial conventionalultrasonic measurement and strain rate parameters in the three groups.Results①The difference of gender, heart rate, blood pressure in three groups were nosignificant（P＞0.05）. Compared with the youth group and mid-age group, the LVIDd andLVIDs were larger, and LVEF was lower in old-age group. But the difference were nosignificant（P＞0.05）. In old-age group, the LAD, LAVmax, LAVmin,LAVpreA, ALAEFwere higher and the TLAEF, PLAEF were lower than youth and mid-age groups, thedifference were significant(P＜0.05). The peak E and A were no significant difference in threegroups（P＞0.05）, but the E/A was much lower and the DT was much longer in old-agegroup(P＜0.05).②Of three groups the left atrial strain rate in side wall was the highest, lowest inseptum(P＜0.05), anterior and posterior wall were no significant difference（P＞0.05）. Thestrain rate in basic segment was higher(P＜0.05), the middle and upside period were nosignificant difference（P＞0.05）. In old-age group, the SRs and SRe were lower than youthand mid-age groups, but the SRa is higher(P＜0.05).③The basic segment TPLS in old-age group was longer than youth and mid-age groups.Compared with youth group, the mid-period TPLS were longer in mid-age and old-age groups(P＜0.05).④The global strain rate of left atrial SRs with TLAEF, SRe with PLAEF, SRa withALAEF were greatly correlated(P＜0.05).Conclusions STI could accurately evaluate the left atrial function, and give the normalreference value of strain rate in different period ages. As the growth of the age, the leftfunction decline gradually, the left atrial posterior and side segment strain rate were as asensitive predictors of early function changing. PartⅡ Two-dimensional speckle tracking imaging for functionalquantification of left atrial in patients with atrial fibrillationbefore and after catheter ablationObjective Using STI technology to evaluate the left atrial function in the patients withatrial fibrillation before and after catheter ablation. Observe the variation regulation and trendof left atrial segment strain rate, and summarize the sensitive left atrial strain rate parameterafter catheter ablation. Determine the possibility index which can represent the recurrent ofatrial fibrillation and provide imaging basis of late curative effect, therapeutic schedule, andprognosis.Methods A total of48patients with atrial fibrillation were under the catheter ablationin Department of Cardiography Changhai Hospital during January,2012and December,2013,which were included in the present study, of which33were with paroxysmal atrialfibrillation(18male and15female, average age65.8±12.41) and15were with persist atrialfibrillation(9male and6female, average age68.6±11.48). All the patients receivedechocardiography at1day before the surgery and3days,3months,6months after the surgery,collecting a series of two-dimensional strain results of the left atrial.48age matched healthypeople were chosen from the partⅠobservables as normal control group. Record the left atrialand left ventricle normal parameters, collected and saved a series of left atrial two-dimensional dynamic ultrasound images. Using the STI to analysis the images andestablish the database. Anlysing the left atrial conventional ultrasonic measurement and strainrate parameters in the three groups.Results All the patients were successfully converting to sinus rhythm after the catheterablation3days. At6months follow-up,33cases of patients with paroxysmal atrial fibrillationrecurrence of atrial fibrillation, observed in4patients more than29cases were maintain sinusrhythm;6cases in15patients with persistent AF after surgery to maintain sinus rhythm, AFrecurrence was observed in all9patients.①There were no significant difference in gender, blood pressure among the paroxysmalAF group, persistent AF group and controls(P＞0.05). The heart rate was much faster inpersistent AF group compared with controls(P＜0.05).②There were no significant difference in LVIDd, LVIDs, LVEF before or after thesurgery neither in paroxysmal AF group nor in persistent AF group(P＞0.05).③Compared with normal control group, preoperative LAD in paroxysmalAF group waslarger, the E/A ratio was reduced, and DT prolonged(P＜0.05). Postoperative3months E/Avalue increases, DT time shorted, but there were no statistically significant differencecompared with preoperative(P＞0.05). After6months, E/A value was significantly increased,DT also decreased significantly, but the level was lower than the normal control group(P＜0.05).④PersistentAF groups left atrial stain rate in preoperative was lower than normal controlgroup(P＜0.05), paroxysmal AF group and normal control group were no significantdifference(P＞0.05).⑤3days postoperative, paroxysmalAF group on the left atrial wall of each section of thestrain rate values were reduced compared with preoperative. Postoperative3months, theupside period of strain rate were increased, but which were still lower than normal controlgroup(P＜0.05).⑥Postoperative6months, the patients who could maintain sinus rhythm performancehigher left atrial strain rate values. Yet recurrence in patients with atrial fibrillation, the strainrate values further decreased(P＜0.05).Conclusions The left atrial function was reduced in patients with atrial fibrillation,especially in patients with persistent AF. After catheter ablation, left atrial myocardialdeformation ability reduced. STI technology could evaluate left atrial function in patients with atrial fibrillation, and could be used as a predictor of recurrence of atrial fibrillation.