Objective To evaluate the relationship between atrial synchrony and paroxysmal atrial fibrillation (PAF) in patients with sick sinus syndrome (SSS) by two-dimensional speckle tracking imaging. Methods Forty-four SSS patients who underwent echocardiographic examination at Department of Ultrasound, No. 2 Hospital of Yinzhou in Ningbo City of Zhejiang Province from January 2015 to August 2016 were enrolled, including 25 without PAF and 19 with PAF. Twenty-eight normal adults who underwent echocardiographic examination at this department at the same time were included as a normal control group. The structural and functional parameters of the left ventricle of all enrolled subjects were evaluated by echocardiographic examination. After two-dimensional speckle tracking images of the right atrium free wall, atrial septum, and left atrium free wall were obtained, the time interval from the initial point of P wave on electrocardiograph to the second negative wave of the diastolic phase in two-dimensional speckle tracking images were measured to calculate the electrical-mechanical time of the right atrium free wall (P-RA), the electrical-mechanical time of the atrial septum (P-IAS), and the electrical-mechanical time (P-LA) of the left atrium free wall. Subsequently, the parameters of atrial synchrony were calculated. Conventional echocardiographic parameters, P-RA, P-IAS, P-LA, and the parameters of atrial synchrony were compared among the three groups by one-way ANOVA, and further comparisons between any two groups were performed by the SNK-q test. The relationship between the parameters of electrical-mechanical time, parameters of atrial synchrony, and PAF were analyzed by Spearman correlation analysis. Receiver operating characteristic curve (ROC) analysis was then performed to evaluate the value of the parameters of electrical-mechanical time and parameters of atrial synchrony in predicting PAF. Results The left atrial size was significantly larger in the SSS without PAF group and SSS with PAF group than in the normal control group (q=4.18, 5.37, both P＜0.05), although there was no significant difference between the SSS without PAF group and SSS with PAF group. The P-RA and P-IAS were significantly larger in the SSS without PAF group and SSS with PAF group than in the normal control group (q=4.03, 4.10; q=4.16, 4.31, all P＜0.05), but there was no significant difference between the SSS without PAF group and SSS with PAF group. The P-LA, right atrial intra-atrial synchrony, left atrial intra-atrial synchrony, and inter-atrial synchrony showed a gradually rising trend from the normal control group to the SSS without PAF group and SSS with PAF group, and the difference between any two groups was statistically significant (q=5.18, 11.23, 4.43; q=5.25, 11.74, 4.63; q=7.38, 14.67, 4.73; q=8.01, 16.37, 6.39, all P＜0.05). Spearman correlation analysis showed that P-LA, right atrial intra-atrial synchrony, left atrial intra-atrial synchrony, and inter-atrial synchrony were significantly positively correlated with PAF in patients with SSS (r=0.61, 0.55, 0.75, 0.78, all P ＜ 0.01), and the correlation between inter-atrial synchrony and PAF was the highest. ROC analysis demonstrated the optimal threshold of P-LA for prediction of PAF was 94 ms [sensitivity: 68.42%; specificity: 76.00%; the area under the ROC curve (AUC): 0.764 (95% CI: 0.612-0.879)]; the optimal threshold of right atrial intra-atrial synchrony was 19 ms [sensitivity: 57.89%; specificity: 76.00%; AUC: 0.714 (95% CI: 0.558-0.840)];the optimal threshold of left atrial intra-atrial synchrony was 42 ms [sensitivity: 78.95%; specificity: 76.00%;AUC: 0.860 (95% CI : 0.722-0.946)]; and the optimal threshold of inter-atrial synchrony was 68 ms [sensitivity:84.21%; specificity: 84.00%; AUC: 0.859 (95% CI: 0.721-0.945)]. These results suggest that left atrial intra-atrial synchrony and inter-atrial synchronization are superior to right atrial intra-atrial synchrony in predicting PAF in patients with SSS. Conclusion Atrial electro-mechanical motion time parameters and synchrony parameters are closely related to PAF in patients with SSS, and left atrial intra-atrial synchrony and inter-atrial synchronization are the most effective parameters in predicting PAF in patients with SSS.%目的 采用二维斑点追踪技术评价心房同步性与病态窦房结综合征伴发阵发性心房颤动的关系.方法 收集2015年1月至2016年8月在浙江省宁波市鄞州第二医院超声科行超声心动图检查的病态窦房结综合征患者.选择病态窦房结综合征不伴发阵发性心房颤动患者25例(病态窦房结综合征A组),病态窦房结综合征伴发阵发性心房颤动患者19例(病态窦房结综合征B组).选择同期本科行超声心动图检查的健康志愿者28名作为健康对照组.采用超声心动图评价所有受检者左心室结构和功能参数,在获取右心房游离壁、房间隔和左心房游离壁二维斑点追踪图像后,测量心电图P波起始点至图像上舒张期第二个负向波的时间间期,代表右心房游离壁电-机械运动时间(P-RA)、房间隔电-机械运动时间(P-IAS)和左心房游离壁电-机械运动时间(P-LA),计算心房同步性参数.采用单因素方差分析比较3组受检者常规超声心动图参数、P-RA、P-IAS、P-LA及心房同步性参数差异,进一步组间两两比较采用SNK-q检验;采用Spearman相关分析法分析心房电-机械运动时间参数、心房同步性参数与阵发性心房颤动的相关性;绘制应用心房电-机械运动时间参数、心房同步性参数预测病态窦房结综合征伴发阵发性心房颤动的受试者工作特征(ROC)曲线.结果 病态窦房结综合征A组、病态窦房结综合征B组患者左心房前后径(LAD)均大于健康对照组受检者,且差异均有统计学意义(q=4.18、5.37,P均＜0.05);而病态窦房结综合征A组与病态窦房结综合征B组患者LAD差异无统计学意义.病态窦房结综合征A组、病态窦房结综合征B组患者P-RA、P-IAS均大于健康对照组受检者,且差异均有统计学意义(q=4.03、4.10;q=4.16、4.31,P均＜0.05),但病态窦房结综合征A组与病态窦房结综合征B组患者P-RA、P-IAS差异均无统计学意义;P-LA、右心房内同步性、左心房内同步性和左右心房间同步性均为健康对照组＜病态窦房结综合征A组＜病态窦房结综合征B组,且任意两组间差异均有统计学意义(q=5.18、11.23、4.43;q=5.25、11.74、4.63;q=7.38、14.67、4.73;q=8.01、16.37、6.39,P均＜0.05).Spearman相关分析结果显示,P-LA、右心房内同步性、左心房内同步性和左右心房间同步性与病态窦房结综合征伴发阵发性心房颤动均呈正相关(r=0.61、0.55、0.75、0.78,P均＜0.01),其中,左右心房间同步性与与病态窦房结综合征伴发阵发性心房颤动的相关性最佳.ROC曲线显示,P-LA预测病态窦房结综合征伴发阵发性心房颤动的最佳阈值为94 ms,敏感度和特异度分别为68.42%和76.00%,曲线下面积为0.764(95% CI 0.612~0.879);右心房内同步性预测病态窦房结综合征伴发阵发性心房颤动的阈值为19 ms,敏感度和特异度分别为57.89%和76.00%,曲线下面积为0.714(95% CI 0.558~0.840);左心房同步性预测病态窦房结综合征伴发阵发性心房颤动的阈值为42 ms,敏感度和特异度分别为78.95%和76.00%,曲线下面积为0.860(95% CI 0.722~0.946);左右心房间同步性预测病态窦房结综合征伴发阵发性心房颤动的阈值为68 ms,敏感度和特异度分别为84.21%和84.00%,曲线下面积为0.859(95% CI 0.721~0.945);ROC曲线下面积显示,左心房内同步性和左右心房间同步性预测病态窦房结综合征伴发阵发性心房颤动的效能优于右心房内同步性.结论 心房电-机械运动时间参数和同步性参数与病态窦房结综合征伴发阵发性心房颤动关系密切.左心房内同步性和左右心房间同步性预测病态窦房结综合征伴发阵发性心房颤动的价值最佳.
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