实时三维超声心动图评估左室不同舒张功能状态的左心房容积与功能

目的 探讨实时三维超声心动图（RT-3DE）评估左心室不同舒张功能状态的左房容积与功能的价值。方法 108名受检者根据左心室不同舒张功能状态分成正常组、顺应性降低组、假性正常化组及限制性充盈障碍组。RT-3DE测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）、左房收缩前容积（LAVpreA），并对参数用体表面积校正，得出LAVmax指数、LAVmin指数、LAVpreA指数，计算左房整体射血分数（LAEF）、左房被动射血分数（LApassive）、左房主动射血分数（LAactive）。并将RT-3DE所测左房功能相关参数与应用脉冲多普勒及组织多普勒测量反映左室舒张功能相关参数作对比。结果 二尖瓣口舒张期前向峰值血流速度E与二尖瓣前瓣环组织多普勒E，比值（E/ E，）及二尖瓣口舒张期前向峰值血流速度E与二尖瓣口M型彩色多普勒峰值血流速度Vp（E/Vp）随着舒张功能障碍加重而增加，而E峰减速时间（Dct）随着舒张功能障碍加重而降低（P<0.05）; LAVmax 指数、LAVmin指数随舒张功能降低而增加，LAEF随舒张功能降低而降低（P<0.05）; E/ E，、E/Vp及Dct与LAEF相关性相关性最佳，r分别为-0.84，-0.81，0.74（P<0.05）; LAVmax指数≥34ml/m2、LAEF≥30%诊断左室充盈压增高（即E/ E， >15.0），其敏感度和特异度分别为86.0%，66.7%及86.7%，80.6%。结论 RT-3DE为评价左房容积与功能提供了新方法，测得左房功能参数能准确反映左室舒张功能受损程度。

Evaluation Left atrial volume and function with Real-time three-dimensional echocardiography in paients with Left Ventricular Diastolic Dysfunction

ABSTRACT Obiective: To evaluate left atrial volume and function with Real-time three-dimensional echocardiography(RT-3DE) in paients with Left Ventricular Diastolic Dysfunction. Methods: The 108 subjects were divided into 4 groups (normal, impaired relaxation, pseudonormal and restrictive) on the basis of diastolic function. The maximun left atrial volume(LAVmax), minimum left atrial volume (LAVmin ),left atrial volume before atrial active rengui_huang@yahoo.com.cncontraction(LAVpre) were measured by RT-3DE, All LA volumes were calculated by the body surface area got LAVmax index, LAVmin index, LAVpre index. Total atrial imptying fraction(LAEF), passive atrial emptying fraction(LApassive), active atrial emptying fraction(LAactive) were calculated. All left atrail fuction parameters measured by RT-3DE were compared with left ventricular diastolic parameters measured by plused doppler and tissue doppler. Results: The ratio of early diastolic transmitral flow velocity E to early diastolic mitral annular velocity E′(E/ E′) and the ratio of E to transmitral flow propagation velocity Vp (E/Vp) were increased and the deceleration time of E wave(Dct) were decreased with the severity of left ventricular diastolic dysfunction（P<0.05）. LAVmax index and LAVmin index was dilated in subjects with left ventricular diastolic dysfunction, whereas the LA ejection fraction was lower（P<0.05）. The LA ejection fraction correlated best with E/E′，E/Vp and Dct (r =-0.84，-0.81，0.74，P<0.05) . LAVmax index≥34ml/m2 had a sensitivity of 93.3% and a specificity of 84.6% and LAEF≥30% had a sensitivity of 93.3% and a specificity of 84.6% for predicting deteriorating left ventricular diastolic dysfunction(E/ Erengui_huang@yahoo.com.cncontraction(LAVpre) were measured by RT-3DE, All LA volumes were calculated by the body surface area got LAVmax index, LAVmin index, LAVpre index. Total atrial imptying fraction(LAEF), passive atrial emptying fraction(LApassive), active atrial emptying fraction(LAactive) were calculated. All left atrail fuction parameters measured by RT-3DE were compared with left ventricular diastolic parameters measured by plused doppler and tissue doppler. Results: The ratio of early diastolic transmitral flow velocity E to early diastolic mitral annular velocity E′(E/ E′) and the ratio of E to transmitral flow propagation velocity Vp (E/Vp) were increased and the deceleration time of E wave(Dct) were decreased with the severity of left ventricular diastolic dysfunction（P<0.05）. LAVmax index and LAVmin index was dilated in subjects with left ventricular diastolic dysfunction, whereas the LA ejection fraction was lower（P<0.05）. The LA ejection fraction correlated best with E/E′，E/Vp and Dct (r =-0.84，-0.81，0.74，P<0.05) . LAVmax index≥34ml/m2 had a sensitivity of 93.3% and a specificity of 84.6% and LAEF≥30% had a sensitivity of 93.3% and a specificity of 84.6% for predicting deteriorating left ventricular diastolic dysfunction(E/ E′ >15.0). Conclusion: New method measuring Left atrial volume and function were provided by RT-3DE. The left atrail fuction parameters could reflect severity of left ventricular diastolic dysfunction. >15.0). Conclusion: New method measuring Left atrial volume and function were provided by RT-3DE. The left atrail fuction parameters could reflect severity of left ventricular diastolic dysfunction.