四维自动左房定量技术评价尿毒症血液透析患者左房功能

目的：心血管损伤是尿毒症血液透析患者的主要并发症,左房形变与左室充盈压及功能障碍有关,目前量化左房功能仍有一定挑战。本研究探讨四维自动左房定量(LAQ)技术评估保留左室射血分数(LVEF)的尿毒症血液透析患者的左房功能。方法：选取LVEF正常的尿毒症血液透析患者37例和正常对照组34例,所有参与者行常规超声心动图和LAQ检查。主要采集胸骨旁左室长轴和心尖四腔心切面图像,通过脱机分析软件EchoPac 203测量左房直径、容积、射血分数和应变参数,并对两组进行分析比较。结果：与正常对照组相比,尿毒症组的左室扩大、左室壁肥厚,左房直径和容积增加,左房排空分数虽有一定降低,但仍在正常范围内。左房储存、管道及辅泵期的纵向应变均降低,周向应变仅储存和管道期降低,辅泵期无明显差异。结论：尿毒症血液透析患者的心肌损害早于LVEF异常,左房应变比常规超声参数更敏感、更早期发现左房结构和功能的损害。LAQ作为一种新方法,可早期检出LVEF正常的尿毒症患者的左房功能障碍,为临床早期诊疗提供有价值的信息。

Estimation of Left Atrial Function Using Four-Dimensional Auto Left Atrial Quantify Echocardiography in Patients with Uremia

ABSTRACT objective: Cardiovascular impairment is an important complication of uremia undergoing hemodialysis therapy. Left atrial (LA) deformation is closely related to left ventricular filling pressure and dysfunction, but quantification of LA dysfunction remains a challenge. The purpose of this study was to evaluate the LA function in uremia patients with preserved left ventricular ejection fraction (LVEF) using four-dimensional auto left atrial quantification (LAQ). Methods: Thirty-seven uremia patients on hemodialysis and 34 healthy individuals were enrolled in the study. All participants underwent conventional echocardiographic examinations and LAQ. The measurements of LA dimension, volume, emptying fraction, and longitudinal/circumferential strain parameters during triphasic were obtained from the left ventricular long axis and apical four-chamber views, which were taken offline using software (GE EchoPac 203), and the results of two groups were compared and analyzed. Results: Compared with those of the control group, left ventricular dimension and wall thickness, LA dimension and volume were increased in patients with uremia. LA emptying fraction is decreased but in the normal range. The longitudinal strain during reservoir, conduit and pump phase were significantly lower, while the circumferential strain was lower during reservoir and conduit phases. Conclusion: The myocardial damage in uremia dialysis patients was impaired before the abnormality of LVEF. LA strain is more sensitive than traditional echocardiographic parameters to detect LA structural and functional damage. LAQ provided a new and advanced method, we can further demonstrate and quantify these changes, which could provide useful information for clinical practice.