Статья
ФУНКЦИЯ ЛЕВОГО ПРЕДСЕРДИЯ: СОВРЕМЕННЫЕ МЕТОДЫ ОЦЕНКИ И КЛИНИЧЕСКОЕ ЗНАЧЕНИЕ
Оценка функции левого предсердия (ЛП) является важным аспектом всестороннего исследования компетентности сердечно-сосудистой системы. Многочисленные кардиальные заболевания могут влиять на работу ЛП, как непосредственно воздействуя на миокард предсердий, так и путем изменения состояния гемодинамики. Принято считать, что давление в ЛП и в левом желудочке в диастолу взаимозависимы, поэтому в отсутствие патологии митрального клапана расширение предсердия является признаком увеличения давления наполнения желудочка. Изучение размера и функции левого предсердия как функции накопления, протекания и насоса может предсказывать сердечно-сосудистые события при кардиомиопатиях, ишемической болезни сердца и клапанных пороках. В последние два десятилетия появились новые методики, связанные, прежде всего с тканевыми допплеровскими технологиями, которые обеспечивают достаточно точную и всестороннюю оценку механики левого предсердия. Деформация и скорость деформации, полученные ультразвуковой методикой «след пятна», представляет легко выполнимую и воспроизводимую технологию оценки механики левого предсердия.В нормальных условиях ЛП представляет собой очень растяжимую камеру с относительно низким давлением. Однако при остром или хроническом повреждающем воздействии происходит растяжение стенки ЛП. Расширение ЛП является признаком изменения его структуры с развитием фиброза, что отражается на показателях деформации и скорости деформации ЛП. Оценка деформации ЛП может быть полезной в предсказании успешности восстановления и сохранения синусового ритма после кардиоверсии и катетерной абляции. Низкие значения глобальной деформации ЛП указывают на необратимое ремоделирование ЛП и связаны с прогрессированием фибрилляции предсердий от пароксизмальной формы к постоянной. Наиболее интересным в этой связи представляется потенциальный вклад эхокардиографии в стратификацию тромбоэмболического риска при фибрилляции предсердий и процедурах инвазивного вмешательства. Поэтому основной задачей в настоящее время является понимание точек клинического приложения полученных в ходе исследования ЛП данных применительно к текущей практике.
1. Barbier P., Solomon S.B., Schiller N.B., Glantz S.A. Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function. Circulation 1999;100:427–36.
2. Hoit B.D. Left Atrial Size and Function. Role in Prognosis. J Am Coll Cardiol 2014;63:493–505.
3. Marwick T.H., Yu Ch.-M., Sun J.P. Myocardial Imaging: Tissue Doppler and Speckle Tracking. Chapter 21. Zhang Q, Yu Ch-M. Atrial function. Blackwell Publishing 2007;P.255-264.
4. Abhayaratna W.P., Seward J.B., Appleton C.P., et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 2006; 47: 2357-63.
5. Thomas L., Levett K., Boyd A., et al. Changes in regional left atrial function with aging: evaluation by Doppler tissue imaging. Eur J Echocardiogr 2003; 4: 92-100.
6. Triposkiadis F., Pitsavos C., Boudoulas H., et al. Left atrial myopathy in idiopathic dilated cardiomyopathy. Am Heart J 1994; 128: 308-15.
7. Tsang T.S., Abhayaratna W.P., Barnes M.E., et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol 2006;47:1018-23.
8. Lang R., Badano L., Mor-Avi V., et al. Recommendations for Cardiac Chamber quantification by Echocardiography in Adults: An Update from the American Society echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015;28:1-39.
9. Piotrowski G., Goch A., Wlazlowski R., et al. Non-invasive methods of atrial function evaluation in heart diseases. Med Sci Monit 2000; 6: 827-39.
10. Nagueh S., Smiseth O., Appleton C., et al. Recommendations for the Evaluation of Left ventricular Diastolic Function by Echocardiography: An Update from the American Society of echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2016;29:277-314.
11. Mor-Avi V., Lang RM., Badano L.P., et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 2011;24: 277-313.
12. Wolf F., Ourednicek P., Loewe C., et al. Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency catheter ablation: comparison of a manual and automated 3D volume segmentation method. Eur J Radiol 2010;75:141-6.
13. Kuppahally S.S., Akoum N., Burgon N.S., et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 2010;3:231-9.
14. Miyasaka Y., Tsujimoto S., Maeba H., et al. Left atrial volume by real-time three-dimensional echocardiography: validation by 64-slice multidetector computed tomography. J Am Soc Echocardiogr 2011;24:680-6.
15. Artang R., Migrino R.Q., Harmann L., et al. Left atrial volume measurement with automated border detection by 3-dimensional echocardiography: comparison with magnetic resonance imaging. Cardiovasc Ultrasound 2009;7:16.
16. Hoit B.D., Shao Y., Gabel M., Walsh R.A. Inяuence of loading conditions and contractile state on pulmonary venous яow. Validation of Doppler velocimetry. Circulation 1992;86: 651-9.
17. Appleton C.P., Galloway J.M., Gonzalez M.S., et al. Estimation of left ventricular filling pressures us-ing two-dimensional and Doppler echocardiography in adult patients with cardiac disease: additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral яow velocity at atrial contraction. J Am Coll Cardiol 1993;22:1972-82.
18. Korinek J., Wang J., Sengupta P.P., et al. Two-dimensional strain—a Doppler-independent ultrasoundmethod for quantitation of regional deformation: validation in vitro and in vivo. J Am Soc Echocardiogr 2005;18:1247-53.
19. Cho G.Y., Chan J., Leano R., et al. Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging. Am J Cardiol 2006;97:1661-6.
20. Leischik R., Littwitz H., Dworrak B., et al. Echocardiographic Evaluation of Left Atrial Mechanics: Function, History, Novel Techniques, Advantages, and Pitfalls. BioMed Research International. 2015;765921.
21. To A.C., Flamm S.D., Marwick T.H., Klein A.L. Clinical utility ofmultimodality LA imaging: assessment of size, function, and structure. JACC Cardiovasc Imaging 2011;4:788-98.
22. Матановская Т.В., Туев А.В., Орехова Е.Н., Суханов С.Г. Оценка механической функции левого предсердия у здоровых взрослых. Пермский медицинский журнал. 2014;31(1):64-71.
23. Cameli M., Lisi M., Righini F.M., Mondillo S. Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound 2012;10:4.
24. Saraiva R.M., Demirkol S., Buakhamsri A., et al. Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 2010;23:172-80.
25. Vieira M.J., Teixeira R., Goncalves L., Gersh B.J. Left Atrial Mechanics: Echocardiographic Assessment and Clinical Implications. J Am Soc Echocardiogr 2014;27:463-78.
26. Ebato M., Maezawa H., Tanabe A., et al. Left atrial area strain measured by three dimensional speckle tracking echocardiography represents global and regional left atrial function at once. J Am Coll Cardiol 2012;59:E1269.
27. Nattel S. Electrophysiologic remodeling. J Cardiov Electrophys 1999;10:1553-6.
28. Cameli M., Lisi M., Focardi M., et al. Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol 2012;110:264-9.
29. Møller J.E., Hillis G.S., Oh J.K., et al. Left atrial volume: A powerful predictor of survival after acute myocardial infarction. Circulation 2003;107:2207-12.
30. Tsang T.S., Barnes M.E, Gersh B.J, et al. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol 2002;90: 1284-9.
31. Kurt M., Tanboga I.H., Aksakal E., et al. Relation of left ventricular end-diastolic pressure and N-terminal pro-brain natriuretic peptide level with left atrial deformation parameters. Eur Heart J Cardiovasc Imaging 2012;13:524-30.
32. Benjamin E.J., D’Agostino R.B., Belanger A.J., et al. Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 1995;92:835-41.
33. Takemoto Y., Barnes M.E., et al. Usefulness of left atrial volume in predicting first congestive heart failure in patients ≥ 65 years of age with well-preserved left ventricular systolic function. Am J Cardiol 2005;96:832-6.
34. Gottdiener J.S., Kitzman D.W., Aurigemma G.P., et al. Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons > or = 65 years of age (the Cardiovascular Health Study). Am J Cardiol 2006;97:83-9.
35. Antoni M.L., ten Brinke E.A., Atary J.Z., et al. Left atrial strain is related to adverse events in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Heart 2011;97:1332-7.
36. Shao C., Zhu J., Chen J., Xu W. Independent prognostic value of left atrial function by two-dimensional speckle tracking imaging in patients with non -ST-segment-elevation acute myocardial infarction. BMC Cardiovascular Disorders. 2015;15:145-153.
37. Santos A.B.S., Roca G.Q., Claggett B., et al. Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction. Circulation: Heart Failure. 2016;9:e002763.
38. Di Salvo G., Caso P., Lo Piccolo R., et al. Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study. Circulation 2005;112:387-95.
39. Goldberg A., Kusunose K., Qamruddin S., et al. Left Atrial Size and Function in a Canine Model of Chronic Atrial Fibrillation and Heart Failure. PLoS ONE. 2016;11(1):e0147015.
40. Donal E., Ollivier R., Veillard D., et al. Left atrial function assessed by trans-thoracic echocardiography in patients treated by ablation for a lone paroxysmal atrial fibrillation. Eur J Echocardiogr 2010;11: 845-52.
41. Yoon E.Y., Oh I.-Y., Kim S.-A., et al. Echocardiographic Predictors of Progression to Persistent or Permanent Atrial Fibrillation in Patients with Paroxysmal Atrial Fibrillation (E6P Study). J Am Soc Echocardiogr 2015;28:709-17.
42. Motoki H., Negishi K., Kusunose K., et al. Global Left Atrial Strain in the Prediction of Sinus Rhythm Maintenance after Catheter Ablation for Atrial Fibrillation. J Am Soc Echocardiogr 2014;27: 1184-92.
43. Henein M.Y., Holmgren A., Lindqvist P. Left atrial function in volume versus pressure overloaded left atrium. Int J Cardiovasc Imaging 2015;31(5);959-65.
44. Ancona R., Pinto S.C., Caso P., et al. Two-dimensional atrial systolic strain imaging predicts atrial fibrillation at 4-year follow-up in asymptomatic rheumatic mitral stenosis. J Am Soc Echocardiogr 2013;26:270-7.
45. Nakajima H., Seo Y., Ishizu T., et al. Analysis of the left atrial appendage by three-dimensional transesophageal echocardiography. Am J Cardiol 2010;106:885-92.
46. Calkins H., Kuck K.H., Cappato R., et al. 2012HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012;14:528-606.
47. Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for themanagement of atrial fibrillation developed in collaboration with EACTS. European Heart Journal 2016;37:2893-2962.
48. Floria M., Roy L.D., Xhaet O., et al. Predictive value of thromboembolic risk scores before an atrial fibrillation ablation procedure. J Cardiovasc Electrophysiol 2013;24:139-45.
49. Providencia R., Botelho A., Trigo J., et al. Possible refinement of clinical thromboembolism assessment in patients with atrial fibrillation using echocardiographic parameters. Europace 2012;14:36-45.
50. Wasmer K., Kobe J., Dechering D., et al. CHADS2 and CHA2DS2-VASc score of patients with atrial fibrillation or яutter and newly detected left atrial thrombus. Clin Res Cardiol 2013;102:139-44.
51. McCready J.W., Nunn L., Lambiase P.D., et al. Incidence of left atrial thrombus prior to atrial fibrillation ablation: is pre-procedural transoesophageal echocardiography mandatory? Europace Jul 2010;12:927-32.
52. Willens H.J., Gomez-Marın O., Nelson K., et al. Correlation of CHADS2 and CHA2DS2-VASc scores with transesophageal echocardiography risk factors for thromboembolism in a multiethnic United States population with nonvalvular atrial fibrillation. J Am Soc Echocardiogr 2013;26:175-84.
53. Providencia R., Trigo J., Paiva L., Barra S. The Role of Echocardiography in Thromboembolic Risk Assessment of Patients with Nonvalvular Atrial Fibrillation. J AmSoc Echocardiogr 2013;26:801-12.
54. Ayirala S., Kumar S., O’Sullivan D.M., Silverman D.I. Echocardiographic predictors of left atrial appendage thrombus formation. J Am Soc Echocardiogr 2011;24:499-505.
55. Shih J.Y., Tsai W.C., Huang Y.Y., et al. Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation. J Am Soc Echocardiogr 2011;24:513-9.
56. Hsu P.-C., Lee W.-H., Chu C.-Y., et al. Prognostic role of left atrial strain and its combination index with transmitral E-wave velocity in patients with atrial fibrillation. Scientific RepoRts. 2016;6:17-18.
57. Azemi T., Rabdiya V.M., Ayirala S.R., et al. Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS2 scores. J Am Soc Echocardiogr 2012;25:1327-32.
58. Kim D., Shim C.Y., Hong G.-R., et al. Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients With Stroke. Stroke. 2016;47:1444-1451.
59. Kowallick J.T., Lotz J., HasenfuІ G., Schuster A. Left atrial physiology and pathophysiology: Role of deformation imaging. World J Cardiol. 2015;7(6):299-305. DOI: 10.4330/wjc.v7.i6.299
60. Dinh T., Baur L.H., Pisters R., et al. Aspirin versus vitamin K antagonist treatment guided by transoesophageal echocardiography in patients with atrial fibrillation: a pilot study. Heart 2014;100(7): 563-8.
61. Ruff C.T., Giugliano R.P., Antman E.M., et al. Evaluation of the novel factor Xa inhibitor edoxaban compared with warfarin in patients with atrial fibrillation: design and rationale for the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction Study 48 (ENGAGE AF-TIMI 48). Am Heart J 2010;160:635-41.
62. Link M.S., Giugliano R.P., Ruff C.T., et al. Stroke and Mortality Risk in Patients With Various Patterns of Atrial Fibrillation. Results From the ENGAGE AF-TIMI 48 Trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48). Circ Arrhythm Electrophysiol. 2017;10:e004267.