应用组织速度成像技术评价冠心病患者并发肺动脉高压对心房功能影响的临床研究

目的探讨组织速度成像技术及左房容积指数定量评价冠心病肺动脉高压患者左房功能的价值。方法冠心病患者153例,根据有或无肺动脉压增高将患者分为肺动脉高压组(PH组)和无肺动脉高压组(NPH组)。测量左房被动射血分数、主动射血分数、左房容积指数、左房整体及节段运动速度并进行比较。结果与NPH组患者比较,PH患者左房被动射血分数、主动射血分数和左房整体及节段速度均显著降低(P值均<0.01),左房容积指数显著增高(P<0.01)。多元逐步回归结果表明左房容积指数和左房平均组织速度与左房助力泵功能独立相关。结论冠心病合并肺动脉高压患者左房功能减低,组织速度成像技术及左房容积指数均能定量评价患者的左房功能。

Impaired atrial function in patients with coronary artery disease associated with elevated pulmonary artery systolic pressure

Objective To evaluate the impact of elevated pulmonary artery systolic pressure（PASP） on left atrium morphology and function in patients with coronary artery disease（CAD） by Tissue Doppler Imaging.Methods 153 consecutive patients with CAD were enrolled in the study.Detailed echocardiography,including Doppler imaging,was performed to measure PASP,LA volumes,LA passive emptying fraction,LA active emptying fraction and atrial contraction velocities.Results Elevated PASP（〉35mmHg） was confirmed in 46 patients who had significantly lower LA passive empting fraction,LA active empting fraction（43 ± 12 vs 52±12%,P=0.001）,mean Va of LA（4.9±1.3 vs 5.6±1.1 cm/s,P=0.001）,and greater LA diameter,volume and LA volume index（LAVI） compared with those without elevated PASP（all P values 〈0.001）.On multivariate logistic regression analysis,LAVI（Odd ratio=1.18,95% confidence interval1.10~1.26,P〈 0.001） and mean Va（OR=0.45,95% CI 0.29~0.69,P〈0.001） were independent predictors of identifying LA active function in CAD patients with elevated PASP.Conclusion CAD patients with elevated PASP have enlarged LA morphology and reduced regional and global active LA mechanical contraction,indicating significantly depressed atrial conduction in enlarged LA.LAVI and mean Va are important predictors of LA function in CAD patients with elevated PASP.