二维斑点追踪技术联合实时三维超声心动图评价肥胖对原发性高血压患者左房功能的影响

目的：联合应用二维斑点追踪技术（two-dimensional speckle tracking imaging，2D-STI）和实时三维超声心动图 （real-time three-dimensional echocardiography，RT-3DE）评估肥胖对原发性高血压患者左房功能的影响。方法：根据体重指数 （body mass index，BMI）将2022年4月—2023年7月在南京医科大学附属江宁医院确诊的132例原发性高血压患者及114例血压正常的健康对照分为6个亚组。利用2D-STI 联合RT-3DE技术获得左房纵向应变及机械功能指数，比较各组间左房功能差异。结果：与相同BMI 分类的健康对照组相比，高血压组左房储备期应变（left artial reservoir strain，LASr）、左房导管期应变 （left artial conduit strain，LAScd）均下降（P < 0.05）；随BMI增加，高血压组LASr、LAScd、左房总排空分数（total left atrial ejection fraction，LAEFt）、左房被动排空分数（passive left atrial ejection fraction，LAEFp）、左房主动排空分数（active left a trial ejection fraction，LAEFa）均降低（P < 0.05），而左房收缩期应变（left artial contractile strain，LASct）无明显差异（P > 0.05）。多元线性回归显示BMI与高血压组LASr、LAScd、LAEFt、LAEFp、LAEFa均呈独立负相关（P < 0.05），而收缩压与高血压患者左房功能无明显相关（P > 0.05）。结论：高血压可引起左房功能受损，随着BMI的增加特别是合并肥胖后可在一定程度上进一步加重功能损伤。

Evaluation of the effect of obesity on left atrial function in patients with essential hypertension using two⁃dimensional speckle tracking imaging combined with realtime three⁃ dimensional echocardiography

Objective：To evaluate the effect of obesity on left atrial function in patients with essential hypertension by using a combined approach of two-dimensional speckle tracking imaging（2D-STI）and real -time three-dimensional echocardiography（RT-3DE）. Methods：A total of 132 patients diagnosed with essential hypertension and 114 controls with normal blood pressure were enrolled from Jiangning Hospital Affiliated to Nanjing Medical University from April 2022 to July 2023. According to the body mass index（BMI），they were stratified into six subgroups. Left atrial longitudinal strain and mechanical function indices were obtained using the combined 2D-STI and RT-3DE techniques to compare differences in left atrial function among the groups. Results：Compared to the healthy control group with the same BMI category，the hypertension group showed a decrease in left atrial reservoir strain（LASr） and left atrial conduit strain（LAScd）（P < 0.05）；As BMI increased，LASr，LAScd，total left atrial ejection fraction（LAEFt），passive left atrial positive ejection fraction（LAEFp），and active left atrial ejection fraction（LAEFa）decreased in hypertension patients（P < 0.05），while left atrial contractile strain（LASct）showed no significant difference（P > 0.05）. Multivariate linear regression analysis revealed that BMI was independently negatively correlated with LASr，LAScd，LAEFt，LAEFp and LAEFa in the hypertension group， respectively（P < 0.05），while systolic blood pressure showed no significant correlation with left atrial function in hypertensive patients （P > 0.05）. Conclusion：Hypertension can lead to the impairment of left atrial function and with an increase in BMI，especially when combined with obesity，the damage to left atrial function may be further exacerbated to a certain extent.