二维斑点追踪技术对心房颤动合并功能性二尖瓣反流患者导管消融疗效的评估价值OA

Objective To explore the evaluation value of two-dimensional speckle tracking imaging(2D-STI)in the efficacy of catheter ablation for patients with atrial fibrillation complicated with atrial functional mitral regurgitation(AFMR).Methods A total of 80 patients diagnosed with atrial fibrillation complicated with AFMR and undergoing catheter ablation at Changsha First Hospital between January 2023 and January 2025 were retrospectively enrolled.According to the results of echocardiography at 6 months after operation,the patients were divided into an improvement group(41 cases)and a non-improvement group(39 cases).The 2D-STI parameters[including left atrial reservoir strain(LASr),left atrial conduit strain(LAScd),and left atrial contractile strain(LASct)]were compared between the two groups at 6 months after surgery.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of 2D-STI parameters for the efficacy of catheter ablation in patients with atrial fibrillation complicated with AFMR.Multivariate stepwise logistic regression analysis was used to identify the influencing factors of catheter ablation efficacy in these patients.Results The LASr in the improvement group was significantly higher than that in the non-improvement group,while the LAScd and LASct were significantly lower(P<0.001).ROC curve analysis showed that the areas under the curve(AUC)of LASr,LAScd,and LASct for predicting the efficacy of catheter ablation in patients with atrial fibrillation complicated with AFMR were 0.719,0.738,and 0.702,respectively.The AUC of the combined prediction of the three parameters was 0.907,which was superior to any single parameter(P<0.001).The LAD,CHA2DS2-VASc score,severity of mitral regurgitation(severe),persistent atrial fibrillation,failure to maintain sinus rhythm at 6 months postoperatively,atrial fibrillation detected during echocardiography at 6 months postoperatively,and postoperative atrial fibrillation burden were higher in the non-improvement group than in the improvement group(P<0.05).Multivariate Logistic stepwise regression analysis showed that persistent atrial fibrillation,failure to maintain sinus rhythm at 6 months postoperatively,high LAD,high CHA2DS2-VASc score,and low LASr were independent risk factors for catheter ablation efficacy in patients with atrial fibrillation complicated with AFMR(OR=2.085,95%CI:1.136-3.829,P=0.018;OR=2.210,95%CI:1.262-3.871,P=0.006;OR=2.230,95%CI:1.281-3.883,P=0.005;OR=2.328,95%CI:1.345-4.030,P=0.003;OR=2.532,95%CI:1.533-4.182,P<0.001).Conclusion The left atrial strain parameters measured by 2D-STI,especially LASr,can effectively evaluate the efficacy of catheter ablation in patients with atrial fibrillation and AFMR,and can be combined with clinical indicators to identify high-risk patients with poor prognosis.