实时三维超声心动图和二维斑点追踪成像技术评价高血压病患者左心房功能

目的 探讨实时三维超声心动图(RT-3DE)和二维斑点追踪成像技术(2D-STI)评价高血压病患者左心房功能的价值。 方法 收集健康对照组33例,高血压组56例。应用RT-3DE分别测量左心房最大容积(LAVmax)、左心房收缩前容积(LAVpre)及左心房最小容积(LAVmin),经体表面积(BSA)矫正后,计算出左心房最大容积指数(LAVImax)、左心房收缩前容积指数(LAVIpre)及左心房最小容积指数(LAVImin),并计算左心房每搏量(LASV)、左心房射血分数(LAEF)、左心房被动射血分数(LAPEF)及左心房主动射血分数(LAAEF)。应用2D-STI测得左心房各壁中间段心肌长轴方向运动的应变率曲线,测量左心室收缩期左心房各壁中间段峰值应变率(SRs)、左心室舒张早期和舒张晚期即心房收缩期左心房峰值应变率(SRe和SRa),计算其平均值(即mSRs,mSRe及mSRa),代表左心房整体应变率,并行LAEF与mSRs、LAAEF与mSRa、LAPEF与mSRe的相关性分析。 结果 高血压组的LAVImax,LAVImin,LAVIpre及LASV均大于对照组,而LAEF及LAPEF均小于对照组(P<0.05),2组的LAAEF差别则无统计学意义(P>0.05); 高血压组的mSRs及mSRe均小于对照组(P<0.05),2组的mSRa差别则无统计学意义(P>0.05); mSRe与LAPEF、mSRa与LAAEF、mSRs与LAEF之间呈正相关关系(P<0.01)。 结论 高血压病患者左心房的储蓄及管道功能减弱,可利用RT-3DE联合2D-STI技术从不同角度综合评价患者的左心房功能。

Evaluation of Left Atrial Function in Patients with Hypertension byReal-Time Three-dimensional Echocardiography andTwo-dimensional Speckle Tracking Imaging

ABSTRACT: Objective To evaluate the value of real-time three-dimensional echocardiography(RT-3DE)and two-dimensional speckle tracking imaging(2D-STI)for the left atrial function in patients with hypertension. Methods 33 healthy volunteers as normal control group and 56 hypertension patients were enrolled. By using RT-3DE the left atrial maximal volume(LAVmax), left atrial presystolic volume(LAVpre), and left atrial minimal volume(LAVmin)were measured. The left atrial maximal volume index(LAVImax), left atrial presystolic volume index(LAVIpre), and left atrial minimal volume index(LAVImin)were calculated by dividing the body surface area(BSA). Then the left atrial stroke volume(LASV), left atrial total ejection fraction(LAEF), left atrial passive ejection fraction(LAPEF), and left atrial active ejection fraction(LAAEF)were calculated. The strain rate curves of the long axis of the middle wall of the left atrium(septal, lateral, anterior, inferior and posterior)were acquired by 2D-STI. The left ventricular systolic peak strain rate(SRs), left ventricular early diastolic peak strain rate(SRe), and late diastolic that was left atrial systolic peak strain rate(SRa)were measured. Average strain rate was calculated(mSRs, mSRe, mSRa),which represented the overall strain rate of the left atrium. Finally, the correlation analysis between LAEF and mSRs, LAAEF and mSRa, LAPEF and mSRe were performed. Results Compared with normal group, LAVImax, LAVImin, LAVIpre and LASV were increased in hypertensive group, while LAPEF and LAEF were reduced. The mSRs and mSRe were decreased in comparison to those in the normal group. The above results were statistically significant(P<0.05). There were no significant differences in mSRa or LAAEF between the two groups(P>0.05). There was a positive correlation between mSRe and LAPEF, mSRa and LAAEF, mSRs and LAEF(P<0.01). Conclusions In patients with hypertension, the conduit function and reservoir function were weakened. RT-3DE combined with 2D-STI technique can evaluate the left atrial function in hypertensive patients from different angles, which had good clinical value.