阿托伐他汀对阵发性房颤经导管射频消融术后左房结构和功能的影响
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摘要
目的
1.应用超声心动图观察房颤患者环肺静脉左房线性消融术前后左房结构和功能的变化
2.利用超声心动图探讨阿托伐他汀对房颤患者左房结构及功能影响
方法
入选2008年4月至2009年3月于福建医科大学附属协和医院心内科诊断阵发性房颤患者24例为对照组,均行环肺静脉左房线性消融术(CPVA),术前、术后均予空白对照。2009年4月至2010年3月行CPVA的阵发性房颤患者32例为实验组,术前、术后予阿托伐他汀干预。病人均于术前、术后1天、术后3天、术后5天、术后7天、术后一个月行超声心动图检查,图像存盘,检测病人的左房内径、舒张晚期A峰最大血流速度(VA)、左房充盈分数(AFF)、左房射血力(AEF)、二尖瓣环运动速度(Va),对所得结果进行统计学分析。
结果
1.左房前后径、左右径、上下径术后一个月均较术前减小(P<0.01)。实验组与对照组比较,由均值上看,实验组减少略明显于对照组,但两组对比未见统计学差异(P>0.05)。
2. VA、AFF、AEF术后均明显低于术前(P<0.01),至术后一个月仍低于术前水平(P<0.01)。实验组与对照组比较,由均值上看,实验组略高于对照组,但两组对比未见统计学差异(P>0.05)。,
3.实验组及对照组Va术后均明显低于术前水平(P<0.01),至术后一个月仍低于术前水平(P<0.01)。实验组与对照组比较,由均值上看,实验组略高于对照组,但两组对比未见统计学差异(P>0.05)。
结论
1.使用CPVA术治疗阵发性房颤成功者,左房结构重构可以发生逆转,左房功能术后明显减低,短期内不能恢复至术前水平。
2.阿托伐他汀作用于阵发性房颤的患者,对左房结构及功能的短期影响不明显。
Objectives
1.To observe the changes of left atrial structure and fucntion in patients underwent circumferential pulmonary vein ablation plus left atrial linear ablation using echocardiogram.
2.To investigate the effects of atorvastatin on left atrial fucntion and structure in patients with atrial fibrillation using echocardiogram.
Methods
We enrolled 24 patients with paroxysmal atrial fibrillation who were diagnosed in the department of cardiology at Union Hospital of Fujian Medical University between April 2008 and 2009 March.All patients underwent circumferential pulmonary vein ablation plus left atrial linear ablation(CPVA)and were received blank control before and after the procedure.32 patients with paroxysmal atrial fibrillation who underwent CPVA between April 2009 and 2010 March were in control group. In this groups,patients were assigned to receive atorvastatin before and after the procedure.Echocardiography was performed preoperatively,and immediately ,1 day,3day,5day,7day and 30day after surgery in all patients. Left atrial diameter,the peak velocity of A-wave in late diastole(VA),left atrial filling fraction(AFF),left atrial ejection force(AEF),the peak velocity of mitral annulus by tissue Doppler in late diastole(Va),were measured.
Results
1. One month after the procedure, left atrial anteroposterior dimension,inferosuperior dimension,mediolateral dimension were all decreased in both groups ,(P<0.01). Compared to control group , the atorvastatin group was more obvious on average,but there was not differece in statistics(P>0.05).
2.In both groups, VA,AFF and AEF were distinctly decreased after the procedure(P<0.01),and were still below preoperative level one month after the procedure (P<0.01). Compared to control group , the atorvastatin group was more higher on average,but there was not differece in statistics(P>0.05).
3. Va were significantly lower than preoperative level in both group after the procedure(P<0.01),and were still below preoperative level 1 month after the procedure (P<0.01). Compared to control group , the atorvastatin group was more higher on average,but there was not differece in statistics(P>0.05).
Conclution
1. If CPVA procedure were successfully performed in patients with atrial fibrillation, left atrial reconstitution can be reversed.Left atrial function would distinctly decreased after the procedure,and would not improve in a short time.
2. The effects of Atorvastatin on left atrial fucntion and structure in patients with atrial fibrillation were not evident in a short time .
1.应用超声心动图观察房颤患者环肺静脉左房线性消融术前后左房结构和功能的变化
2.利用超声心动图探讨阿托伐他汀对房颤患者左房结构及功能影响
方法
入选2008年4月至2009年3月于福建医科大学附属协和医院心内科诊断阵发性房颤患者24例为对照组,均行环肺静脉左房线性消融术(CPVA),术前、术后均予空白对照。2009年4月至2010年3月行CPVA的阵发性房颤患者32例为实验组,术前、术后予阿托伐他汀干预。病人均于术前、术后1天、术后3天、术后5天、术后7天、术后一个月行超声心动图检查,图像存盘,检测病人的左房内径、舒张晚期A峰最大血流速度(VA)、左房充盈分数(AFF)、左房射血力(AEF)、二尖瓣环运动速度(Va),对所得结果进行统计学分析。
结果
1.左房前后径、左右径、上下径术后一个月均较术前减小(P<0.01)。实验组与对照组比较,由均值上看,实验组减少略明显于对照组,但两组对比未见统计学差异(P>0.05)。
2. VA、AFF、AEF术后均明显低于术前(P<0.01),至术后一个月仍低于术前水平(P<0.01)。实验组与对照组比较,由均值上看,实验组略高于对照组,但两组对比未见统计学差异(P>0.05)。,
3.实验组及对照组Va术后均明显低于术前水平(P<0.01),至术后一个月仍低于术前水平(P<0.01)。实验组与对照组比较,由均值上看,实验组略高于对照组,但两组对比未见统计学差异(P>0.05)。
结论
1.使用CPVA术治疗阵发性房颤成功者,左房结构重构可以发生逆转,左房功能术后明显减低,短期内不能恢复至术前水平。
2.阿托伐他汀作用于阵发性房颤的患者,对左房结构及功能的短期影响不明显。
Objectives
1.To observe the changes of left atrial structure and fucntion in patients underwent circumferential pulmonary vein ablation plus left atrial linear ablation using echocardiogram.
2.To investigate the effects of atorvastatin on left atrial fucntion and structure in patients with atrial fibrillation using echocardiogram.
Methods
We enrolled 24 patients with paroxysmal atrial fibrillation who were diagnosed in the department of cardiology at Union Hospital of Fujian Medical University between April 2008 and 2009 March.All patients underwent circumferential pulmonary vein ablation plus left atrial linear ablation(CPVA)and were received blank control before and after the procedure.32 patients with paroxysmal atrial fibrillation who underwent CPVA between April 2009 and 2010 March were in control group. In this groups,patients were assigned to receive atorvastatin before and after the procedure.Echocardiography was performed preoperatively,and immediately ,1 day,3day,5day,7day and 30day after surgery in all patients. Left atrial diameter,the peak velocity of A-wave in late diastole(VA),left atrial filling fraction(AFF),left atrial ejection force(AEF),the peak velocity of mitral annulus by tissue Doppler in late diastole(Va),were measured.
Results
1. One month after the procedure, left atrial anteroposterior dimension,inferosuperior dimension,mediolateral dimension were all decreased in both groups ,(P<0.01). Compared to control group , the atorvastatin group was more obvious on average,but there was not differece in statistics(P>0.05).
2.In both groups, VA,AFF and AEF were distinctly decreased after the procedure(P<0.01),and were still below preoperative level one month after the procedure (P<0.01). Compared to control group , the atorvastatin group was more higher on average,but there was not differece in statistics(P>0.05).
3. Va were significantly lower than preoperative level in both group after the procedure(P<0.01),and were still below preoperative level 1 month after the procedure (P<0.01). Compared to control group , the atorvastatin group was more higher on average,but there was not differece in statistics(P>0.05).
Conclution
1. If CPVA procedure were successfully performed in patients with atrial fibrillation, left atrial reconstitution can be reversed.Left atrial function would distinctly decreased after the procedure,and would not improve in a short time.
2. The effects of Atorvastatin on left atrial fucntion and structure in patients with atrial fibrillation were not evident in a short time .
引文
1.周自强,胡大一,陈捷,等.[J]中国心房颤动现状的流行病学研究.中华内科杂志, 2004 ,43 :491– 494 .
2. Benjamin EJ,Wolf PA,d Agostino RB,et al.Impact of Atrial Fibrillation on the Risk of Death : The Framingham Heart Study[J]Circulation, 1998; 98(10): 946– 952
3. Thomas.L, Levett. K,et al,Changes in Regional Left Atrial Function with Aging: Evaluation by Doppler Tissue Imaging,Eur J Echocardiogr,2003,2: 92- 100
4.刘玉学,王欣,等,心房颤动中心房重构机制的研究进展[J],中国胸心血管外科临床杂志,2009,16:218-222
5.侯月梅、张小琴、乔峻,等.风湿性心脏病心房颤动患者左右心耳组织连接蛋白
40和连接蛋白43mRNA水平的对比研究.中华心血管病杂志,2007,35(2):104-142
6.Gaborit N,Steenman M,Lamirault G,et al.Human atrial ion channel and transporter subunit gene-expression remodeling associated with valvular heart disease and atrial fibrillation[J].Circulation,2005,112(4):471-481
7.殷跃辉、石伟,等.他汀类药物抗心房颤动作用[J],心血管病学进展,2008,29:141-143
8.Tesfamariam B,Frohlich BH,Gregg RE,et al.. Differential effects of pravastatin, simvastatin, and atorvastatin on Ca2+ release and vascular reactivity[J]. J Cardiovasc Pharmacol. 1999,34,:95-101
9.Porter KA,Turner NA,O’Regan DJ,et al.Simvastatin reduces human atrial myofibroblast proliferation independently of cholesterol lowering via inhibition of RhoA[J].Cardiovase Res,2004,61,(4):745-755
10.Shiroshita-Takeshita A,Schram G,Lavoie J, et al. Effect of Simvastatin and Antioxidant Vitamins on Atrial Fibrillation Promotion by Atrial-Tachycardia Remodeling in Dogs[J]. Circulation, 2004,110: 2313 - 2319
11.Pappone C,Rosanio S,Oreto G et a1.Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation[J].Cimulation 2000,102:2619-2628
12.Pappone C,Rosanio S,Oreto G et a1.Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study[.J].J Am Coil Cardiol,2003,42:185-197.
[1]Ostrander LD Jr, Brandt RL, Kjelsberg MO, et a1. Electrocardiographic findings among the adult population of a totalnatural community, Tecumseh,michigan. Circulation, 1965, 3l: 888-898
[2]Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.. JAMA, 2001,285: 2370-2375
[3]周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究.中华内科杂志, 2004,43:491-494 .
[4]Hoit BD.Assessing atrial mechanical remodeling and its consequences [J].circ- ulation,2005,112(3):304-306.
[5]Stefanadis C,Dernellis J,Toutouzas P.Evaluation of the left atrial performance using acoustic quantification[J].Echocardiography,1999,16:117-125.
[6]Kagawa K,Arakawa M,Miwa H,et a1.Left atrial functionduring left ventricular diastole evaluated by left atrial angiographyand left ventriculography[J].J Cardiol,1994,24:317-325.
[7]Thamilafasan M,Klein AL,chung MK,et a1. Factors re1ating to left atrial enlargement in atrial fibrillation:“chicken or the egg”hyPothesis[J]Am Hean J,1999,l37:381-383.
[8]Phang Rs,Isserman SM,Karia D,et al. Echocardiographic evidence of left atrial abnormality in young patients with lone paroxysmal atrial fibrillation[J].Am JCardial.2004.94:511-5l3
[9]Ausma J,Wijffels M,Thone F,et al.Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat[J].circu1ation,1997,96:3l57-3163.
[10]Pappone c,0reto G,Rosani0 s,et al . Atrial Electroanatomic Remodeling After Circumferential Radiofrequency Pulmonary Vein Ablation: Efficacy of an Anatomic Approach in a Large Cohort of Patients With Atrial Fibrillation [J].circulation,2001,104:2539-2544
[11]Verma A,Ki1icasIan F,Adams JR,et a1.Extensive ablation during pulmonary antrum isolation has no adverse impact on left function:an echocardiography and cine computed tomography analysis[J]. J cardiovasc Electrophysiol,2006,17(7):741-746.
[12]Beukema WP,Elvan A,sie HT,et a1.Successful Radiofrequency Ablation in Patients With Previous Atrial Fibrillation Results in a Significant Decrease in Left Atrial Size[J].circu1ation,2001;104;2539-2544
[13]Reant P,Lafitte S,Jais P,et a1.Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation [J].Circulation,2005,112(19):2896-903[14]Donal E,Grimm RA,Yamada H,et al. usefulness of Doppler assessment of pulmonary vein and left atrial appendage flow following pu1monany vein isolation of chronic atrialfobrillation jn predicting recovery of left atrial function [J].Am J Cardiol,2005,95:94l一947.
[15]Hesse B.Schuele SU,ThamiIasaran M,et al.A rapid method to quantify left atrial contractile function:Doppler tissue imaging of the mitral annulus during atrial systole[J].Eur J Echocardiogr,2004,5:86-92.
[16]Tomas L,Thomas SP,Hoy M,et al.Comparison of left atrial volume and function after linear ablation and after cardioversion for chronic atrial fibrilation[J].Am J cardiol,2004,93(2):l65-170.
[17]周青,郭瑞强,陈金玲等,应变率显像评价Carto系统引导环肺静脉,消融术对左心房功能的影响,中华超声影像学杂志,2007,16:470-473
[18]周青,郭瑞强,陈金玲等,经导管线性消融技术治疗阵发性房颤对左房进近期功能的影响,中华超声影像学杂志,2007,23:275-277
[19]周永昌,郭万学.超声医学[M].北京:科学技术文献出版社,2006:476
[20]周微微,任卫东等,经食管超声在房颤射频消融治疗前后肺静脉血流动力学变化的临床研究,中国超声医学杂志,2008,24,731-734
[21]薛莉等.声学定量技术对房颤复律前后左房收缩功能的评价.中国急救医学, 2000,11 :670.
[22]王新房、谢明星.超声心动图学[M].北京:人民卫生出版社,2009:54
[23] Kircher B,Abbott JA,Pau S.et a1.Left atrial volume determination by biplane two-dimensional echocardiography : validation by cine computed tomography[J].Am Heart J,199l,l2l(3 Pt 1):864-871
[24]张彦华,朱向明等,实时三维超声心动图定量评价高血压病左房功能的临床研究,江西医学院学报,2009,49,77-80
[25]李方,张运等,实时三维超声心动图检测冠心病左房容量与功能的探讨,山东大学学报,2005,43,585-588
2. Benjamin EJ,Wolf PA,d Agostino RB,et al.Impact of Atrial Fibrillation on the Risk of Death : The Framingham Heart Study[J]Circulation, 1998; 98(10): 946– 952
3. Thomas.L, Levett. K,et al,Changes in Regional Left Atrial Function with Aging: Evaluation by Doppler Tissue Imaging,Eur J Echocardiogr,2003,2: 92- 100
4.刘玉学,王欣,等,心房颤动中心房重构机制的研究进展[J],中国胸心血管外科临床杂志,2009,16:218-222
5.侯月梅、张小琴、乔峻,等.风湿性心脏病心房颤动患者左右心耳组织连接蛋白
40和连接蛋白43mRNA水平的对比研究.中华心血管病杂志,2007,35(2):104-142
6.Gaborit N,Steenman M,Lamirault G,et al.Human atrial ion channel and transporter subunit gene-expression remodeling associated with valvular heart disease and atrial fibrillation[J].Circulation,2005,112(4):471-481
7.殷跃辉、石伟,等.他汀类药物抗心房颤动作用[J],心血管病学进展,2008,29:141-143
8.Tesfamariam B,Frohlich BH,Gregg RE,et al.. Differential effects of pravastatin, simvastatin, and atorvastatin on Ca2+ release and vascular reactivity[J]. J Cardiovasc Pharmacol. 1999,34,:95-101
9.Porter KA,Turner NA,O’Regan DJ,et al.Simvastatin reduces human atrial myofibroblast proliferation independently of cholesterol lowering via inhibition of RhoA[J].Cardiovase Res,2004,61,(4):745-755
10.Shiroshita-Takeshita A,Schram G,Lavoie J, et al. Effect of Simvastatin and Antioxidant Vitamins on Atrial Fibrillation Promotion by Atrial-Tachycardia Remodeling in Dogs[J]. Circulation, 2004,110: 2313 - 2319
11.Pappone C,Rosanio S,Oreto G et a1.Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation[J].Cimulation 2000,102:2619-2628
12.Pappone C,Rosanio S,Oreto G et a1.Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study[.J].J Am Coil Cardiol,2003,42:185-197.
[1]Ostrander LD Jr, Brandt RL, Kjelsberg MO, et a1. Electrocardiographic findings among the adult population of a totalnatural community, Tecumseh,michigan. Circulation, 1965, 3l: 888-898
[2]Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.. JAMA, 2001,285: 2370-2375
[3]周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究.中华内科杂志, 2004,43:491-494 .
[4]Hoit BD.Assessing atrial mechanical remodeling and its consequences [J].circ- ulation,2005,112(3):304-306.
[5]Stefanadis C,Dernellis J,Toutouzas P.Evaluation of the left atrial performance using acoustic quantification[J].Echocardiography,1999,16:117-125.
[6]Kagawa K,Arakawa M,Miwa H,et a1.Left atrial functionduring left ventricular diastole evaluated by left atrial angiographyand left ventriculography[J].J Cardiol,1994,24:317-325.
[7]Thamilafasan M,Klein AL,chung MK,et a1. Factors re1ating to left atrial enlargement in atrial fibrillation:“chicken or the egg”hyPothesis[J]Am Hean J,1999,l37:381-383.
[8]Phang Rs,Isserman SM,Karia D,et al. Echocardiographic evidence of left atrial abnormality in young patients with lone paroxysmal atrial fibrillation[J].Am JCardial.2004.94:511-5l3
[9]Ausma J,Wijffels M,Thone F,et al.Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat[J].circu1ation,1997,96:3l57-3163.
[10]Pappone c,0reto G,Rosani0 s,et al . Atrial Electroanatomic Remodeling After Circumferential Radiofrequency Pulmonary Vein Ablation: Efficacy of an Anatomic Approach in a Large Cohort of Patients With Atrial Fibrillation [J].circulation,2001,104:2539-2544
[11]Verma A,Ki1icasIan F,Adams JR,et a1.Extensive ablation during pulmonary antrum isolation has no adverse impact on left function:an echocardiography and cine computed tomography analysis[J]. J cardiovasc Electrophysiol,2006,17(7):741-746.
[12]Beukema WP,Elvan A,sie HT,et a1.Successful Radiofrequency Ablation in Patients With Previous Atrial Fibrillation Results in a Significant Decrease in Left Atrial Size[J].circu1ation,2001;104;2539-2544
[13]Reant P,Lafitte S,Jais P,et a1.Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation [J].Circulation,2005,112(19):2896-903[14]Donal E,Grimm RA,Yamada H,et al. usefulness of Doppler assessment of pulmonary vein and left atrial appendage flow following pu1monany vein isolation of chronic atrialfobrillation jn predicting recovery of left atrial function [J].Am J Cardiol,2005,95:94l一947.
[15]Hesse B.Schuele SU,ThamiIasaran M,et al.A rapid method to quantify left atrial contractile function:Doppler tissue imaging of the mitral annulus during atrial systole[J].Eur J Echocardiogr,2004,5:86-92.
[16]Tomas L,Thomas SP,Hoy M,et al.Comparison of left atrial volume and function after linear ablation and after cardioversion for chronic atrial fibrilation[J].Am J cardiol,2004,93(2):l65-170.
[17]周青,郭瑞强,陈金玲等,应变率显像评价Carto系统引导环肺静脉,消融术对左心房功能的影响,中华超声影像学杂志,2007,16:470-473
[18]周青,郭瑞强,陈金玲等,经导管线性消融技术治疗阵发性房颤对左房进近期功能的影响,中华超声影像学杂志,2007,23:275-277
[19]周永昌,郭万学.超声医学[M].北京:科学技术文献出版社,2006:476
[20]周微微,任卫东等,经食管超声在房颤射频消融治疗前后肺静脉血流动力学变化的临床研究,中国超声医学杂志,2008,24,731-734
[21]薛莉等.声学定量技术对房颤复律前后左房收缩功能的评价.中国急救医学, 2000,11 :670.
[22]王新房、谢明星.超声心动图学[M].北京:人民卫生出版社,2009:54
[23] Kircher B,Abbott JA,Pau S.et a1.Left atrial volume determination by biplane two-dimensional echocardiography : validation by cine computed tomography[J].Am Heart J,199l,l2l(3 Pt 1):864-871
[24]张彦华,朱向明等,实时三维超声心动图定量评价高血压病左房功能的临床研究,江西医学院学报,2009,49,77-80
[25]李方,张运等,实时三维超声心动图检测冠心病左房容量与功能的探讨,山东大学学报,2005,43,585-588