实时三维超声心动图评价急性心肌梗死患者左房功能及同步性

目的: 应用实时三维超声心动图(RT-3DE)评价急性心肌梗死患者左房功能与同步性。方法: 对30例急性心肌梗死患者（心肌梗死组）及30例健康对照组使用常规超声心动图描记左房心尖四腔心面积(LAA4)及左房心尖两腔心面积(LAA2)。RT-3DE获取心尖四腔心全容积图像，用Qlab 9.0软件获得左室射血分数(LVEF)，左室舒张末容积(LVEDV)，左房最大容积(LAVmax)，左房最小容积(LAVmin)，左房射血分数(LAEF)；结合心电图，在左房时间容积曲线上找到左房收缩前容积(LAVpre)，计算出左房主动排空分数(LAAEF)，左房被动排空分数(LAPEF)。Qlab 9.0软件同时得到左室及左房16节段达收缩期最小容积点时间的标准差(Tmsv16-SD)及最大时间差(Tmsv16-Dif)心率校正值，即Tmsv16-SD/R-R(%)、Tmsv16-Dif/R-R(%)。结果： 心肌梗死组LAA4及LAA2均明显高于健康对照组(P<0.05)；RT-3DE测得心肌梗死组左室LVEF值明显小于健康对照组(P<0.05)，LVEDV、Tmsv16-SD/R-R(%)及Tmsv16-Dif/R-R(%)明显大于健康对照组(P<0.05)；心肌梗死组左房LAVmax、LAVpre、LAEF及LAAEF明显大于健康对照组(P<0.05)，LAVmin、LAPEF、Tmsv16-SD/R-R(%)及Tmsv16-Dif/R-R(%)与健康对照组相比差异无统计学意义(P>0.05)。 结论： RT-3DE能及时反映急性心肌梗死患者左房功能改变及同步性。

valuation of left atrium function and synchrony in patients with acutemyocardial infarction using real-time three-dimensional echocardiography

Objective: Real-time three-dimensional echocardiography(RT-3DE) was applied to evaluate the left atrium function and synchrony in patients with acute myocardial infarction. Methods: Thirty patients with acute myocardial infarction(AMI) and 30 controls were enrolled in the study. Echocardiography was performed to assess the left atrium area of apical 4 chambers (LAA4), and left atrium area of apical 2 chambers(LAA2). RT-3DE was used to obtain full volume images of apical 4 chambers and used QLAB 9.0 software to analyze data, such as left ventricular ejection fraction (LVEF), left ventricular end diastolic volume(LVEDV), left atrial maximal volume(LAVmax), left atrial minimal volume (LAVmin),left atrial eject fraction(LAEF).From the left atrium time volume curve and electrocardiogram, we gained the left atrial presystolic volume(LAVpre). And we caculated the left atrial active emptying fraction(LAAEF) and left atrial passive emptying fraction(LAPEF). We obtained the time of left ventricle and left atrium to minimal systolic volume(Tmsv) of 16 segments and the maximal difference of corresponding segments(Tmsv16 Dif). The above parameters as percentage of the cardiac cycle with different heart rates between patients were also calculated with the QLAB9.0 software, which were Tmsv16-SD /R-R（%）,Tmsv16-Dif/R-R（%）. Results: The LAA4 and LAA2 in AMI group were significantly higher than those of the control(P<0.05). The LVEF detected by RT-3DE in the AMI group was significantly lower than that in the control(P<0.05). The LVEDV,the Tmsv16-SD/R-R(%) and Tmsv16-Dif/R-R（%）of left ventricle in AMI group were significantly higher than those of the control (P<0.05). The LAVmax, LAVpre, LAEF and LAAEF in the AMI group were significantly higher than those of the control (P<0.05). The LAVmin,LAPEF and the Tmsv16-SD/R-R（%） and Tmsv16-Dif/R-R（%） of left atrium in AMI group had no statistical difference from those of the control (P>0.05). Conclusion: RT-3DE can be used to evaluate the left atrium function and synchrony in patients with acute myocardial infarction.