The Relationships Of The SSR Of LAA With The Prognosis Of Radiofrequency Catheter Ablation

Part one:The change of of left atrial and left appendages systole strain rate in patients with atrial fibrillationObjiects:This study tried to evaluate the segments and total function of left atrial (LA) and left atrial appendage (LAA) and to identify the correlation of total function between LA and LAA by systole strain rate (SSR) measured by speckle tracking in atrial fibrillation (AF) patients.Metheds:We studied20controls and89consecutive atrial fibrillation patients (paroxysmal atrial fibrillation(ParAF)64and persistence atrial fibrillation (PerAF)25). The SSR of segments of LA anterior, posterior, lateral, medial (interatrial septum) wall were surved,the total SSR of LA were calculated; also the SSR of segments of LAA lateral, medial wall and the total SSR of LAA.Results:1.The total SSR of LA and LAA of patients were deferent in contrals, ParAF patients and PerAF patients (LA:2.86±0.45VS2.14±0.57VS1.93±0.61P<0.05,LAA:6.23±1.61VS4.44±1.41VS3.67±1.56P<0.05)2.The total SSR of LAA correlation with that of LA either in controls or AF patients (controls:r=0.714P<0.05, ParAF: r=0.564P<0.01, PerAF r=0.423P<0.05).The ratio of total SSR of LAA to that of LA have not difference in3groups (2.24±0.40、2.36±0.59、2.03±0.57)3.The posterior wall has the lowest SSA in all three groups,but the result showed no significance in PerAF group. As to segments,the midpieces have the highest SSA in all groups,but this result have significances in all walls in controls group,have singnifcances in lateral wall and interatrial septum wall in ParAF group,and has singnifcance only in interatrial septum wall in PerAF group. In the segments of LAA, the top pieces have the highest SSA in all groups, this result have significances in both medial wall and lateral wall in controls group, has significance in medial wall only in ParAF group, and has no significance in neither wall in in PerAF group.Conclusions:1. The SSR of AF patients are lower than that of normals, and woud become more lower with progression of AF.2.There are correlations between the SSR of LA and LAA either in normals or AF patients.3.There are discrepancys between the walls and/or segments either in LA or LAA, but it appears the discrepancys will gradually vanish with the progression of AFPart two:The relationship between SSR and pathological AssessmentObjiects:This study was designed to investigate the relationship between SSR and pathological Assessment.Methods:This study involved23rheumatic mitral stenosis patients who underwent valve replacement operation. We surveyed the SSR of LAA before operation and acquired left auricular appendage tissues in operations. Histopathological assessment was performed. The degree of histopathological change was classified into1of4grades. We campared the histopathological results between patients with or without AF.The relationship of SSR of LAA with histopathological results was analysed.Results:These20cases who combination with AF had more cellular hypertrophy(p<0.025), nuclear enlargement (p<0.025), BN (p<0.01), and ICF (p<0.025) than those who with sinus rhythm. Histopathological analyses clearly showed that the grades for intercellular fibrosis, fatty infiltration, endocardial thickening, and nuclear enlargement/abnormalities were significantly and inverselycorrelated with the SSR of LAA (r=0.75, p<0.05; r=0.74, p<0.05; r=0.69, p<0.05;r=0.77, p<0.05,respectively).Conclusions:The SSR can reflecte the degree of pathological changes in myocardiumPart three:The relationships of the SSR of LA and LAA with the prognosis of Radiofrequency catheter ablationObjiects:This study tried to identify the relationships between the SSR of LA and LAA with the prognosis of Radiofrequency catheter ablation.Methods:This studied included58patients who underwent catheter ablation of paroxysmal AF. We surveyed the SSR of LA and LAA before operation and followed up all patients for6months. We compared the SSR of LA and LAA of patients who can maintained sinus rhythm with that of patients who cannot.Then the relationships of the2indexes with the prognosis was studied. The SSR of LA and LAA were significant inverse correlation with the recurrence of arrhythmia,While the plasma concentration of NT-PROBNP were significant positive correlation with the recurrence of arrhythmia. Multivariate regression analysis showed that a lower plasma concentration of NT-PROBNP and higher SSR of LAA were independent predictors of failure of cardioversion (HR,95%CI:0.36,0.14-0.88and2.85,1.33-6.10,respectively).The SSR of LAA combined with plasma concentration of NT-PROBNP improved the sensitivity and specificity for predicting successful of maintain sinus rhythm.