左心房容积参数联合二维斑点追踪成像技术评价非梗阻性肥厚型心肌病患者左心房功能
|
摘要
目的联合左心房容积参数与左心房应变、应变率参数共同评价非梗阻性肥厚型心肌病患者(HCM)的左心房功能。方法选取30例非梗阻性HCM患者及30例年龄和性别均匹配的健康体检者(正常对照组),测量左心房内径(LAD)、左心室舒张末期室间隔厚度(SWD)及左心室后壁厚度(LVPWD);改良双平面bi-Simpson法测量左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)和左心室射血分数(LVEF)。采用容积法测量左心房最大容积(LAVmax)、左心房主动收缩前容积(LAVpre)及左心房最小容积(LAVmin),二维斑点追踪成像技术测量左心房心肌应变(Strain-S、Strain-E and Strain-A)、应变率(Strain rate-S、Stra in ra te-E a nd Stra in ra te-A),分别代表左心房存储、通道及泵功能。结果非梗阻性HCM患者与正常对照组LAD、SWD和LVPWD均明显高于正常对照组(均P<0.01),而LVEDV、LVESV、LVEF、S峰、D峰和Ar峰的差异均无统计学意义(均P>0.05);非梗阻性HCM患者LAVmax、LAVpre、LAVmin、Total LAEV、Passive LAEV和Active LAEV值明显高于正常对照组,而Total LAEF、Pa s s ive LAEF和Ac tive LAEF值明显低于正常对照组,两组间比较差异均有统计学意义(P<0.05或0.01);非梗阻性HCM患者与正常对照组在左心房应变、应变率测值均显著低于正常对照组,差异均有统计学意义(均P<0.01)。结论联合左心房容积参数与应变、应变率参数能够早期评估非梗阻性HCM患者左心房的存储、通道及泵功能,并证明其功能明显受损。
Objective To apply volume-derived values and two-dimensional speckle tracking imaging(2D-STI) in assessment of left atrial(LA) function in patients with non-obstructive hypertrophic cardiomyopathy(HCM). Methods Thirty patients with non-obstructive HCM and 30 age-and gender-matched normal subjects were enrolled in the study. LA volume-derived values(LAVmax, LAVpre, LAVmin)were measured using 2D ultrasonic imaging. The LA strain(Strain-S, Strain-E and Strain-A) and the strain rate(Strain rate-S, Strain rate-E and Strain rate-A), representing the reservoir, conduit and booster pump function respectively, were measured with 2D-STI. Results There were significant differences in LAD, SWD and LVPWD between non-obstructive HCM patients and normal subjects(P<0.05). The LAD,SWD and LVPWD in patients were significantly larger than those normal subjects. No significant differences were found in LVEDV, LVESV,LVEF, S, D and Ar(P >0.05) between two groups. There were significant differences in LA volume-derived values between HCM patients and normal subjects(P<0.05). LAVmax, LAVpre, LAVmin, total LAEV, passive LAEV and active LAEV in HCM patients were significantly larger than those in normal subjects, however, total LAEF, passive LAEF and active LAEF in HCM patients were significantly lower than those in normal subjects. The LA strain(Strain-S, Strain-E and Strain-A) and the strain rate(Strain rate-S, Strain rate-E and Strain rate-A) in patients with non-obstructive HCM were significantly lower than those in normal subjects. Conclusion Volume-derived values and LA strain and strain rate derived from 2D-STI can conveniently demonstrate the LA dysfunction in patients with non-obstructive HCM.
Objective To apply volume-derived values and two-dimensional speckle tracking imaging(2D-STI) in assessment of left atrial(LA) function in patients with non-obstructive hypertrophic cardiomyopathy(HCM). Methods Thirty patients with non-obstructive HCM and 30 age-and gender-matched normal subjects were enrolled in the study. LA volume-derived values(LAVmax, LAVpre, LAVmin)were measured using 2D ultrasonic imaging. The LA strain(Strain-S, Strain-E and Strain-A) and the strain rate(Strain rate-S, Strain rate-E and Strain rate-A), representing the reservoir, conduit and booster pump function respectively, were measured with 2D-STI. Results There were significant differences in LAD, SWD and LVPWD between non-obstructive HCM patients and normal subjects(P<0.05). The LAD,SWD and LVPWD in patients were significantly larger than those normal subjects. No significant differences were found in LVEDV, LVESV,LVEF, S, D and Ar(P >0.05) between two groups. There were significant differences in LA volume-derived values between HCM patients and normal subjects(P<0.05). LAVmax, LAVpre, LAVmin, total LAEV, passive LAEV and active LAEV in HCM patients were significantly larger than those in normal subjects, however, total LAEF, passive LAEF and active LAEF in HCM patients were significantly lower than those in normal subjects. The LA strain(Strain-S, Strain-E and Strain-A) and the strain rate(Strain rate-S, Strain rate-E and Strain rate-A) in patients with non-obstructive HCM were significantly lower than those in normal subjects. Conclusion Volume-derived values and LA strain and strain rate derived from 2D-STI can conveniently demonstrate the LA dysfunction in patients with non-obstructive HCM.
引文
[1]Maron BJ.Hypertrophic cardiomyopathy:A systematic review[J].JAMA,2002,287(10):1308-1320.
[2]Hensley N,Dietrich J,Nyhan D,et al.Hypertrophic cardiomyopathy:a review[J].Anesth Analg,2015,120(3):554-569.
[3]Notomi Y,Lysyansky P,Setser RM,et al.Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging[J].J Am Coll Cardiol,2005,45(12):2034-2041.
[4]韦玮,龚兰,肖俊飞,等.二维斑点追踪技术评价2型糖尿病患者左心房功能[J].医学研究杂志,2017,46(8):171-175.
[5]Saraiva RM,Demirkol S,Buakhamsri A,et al.Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function[J].J Am Soc Echocardiogr,2010,23(2):172-180.
[6]Domsik P,Kalapos A,Chadaide S,et al.Three-dimensional speckle tracking echocardiography allows detailed evaluation of left atrial function in hypertrophic cardiomyopathy-insights from the MAGYAR-Path Study[J].Echocardiography,2014,31(10):1245-1252.
[7]Ho SY,Anderson RH,Sáa nchez-Quintana D.Atrial structure and fibres:morphologic bases of atrial conduction[J].Cardiovasc Res,2002,54(2):325-336.
[8]王妍,何继强,高阅春,等.711例肥厚型心肌病患者临床特征分析[J].中国循环杂志,2011,26(6):434-437.
[9]Welles CC,Ku IA,Kwan DM,et al.Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease:longitudinal data from the Heart and Soul Study[J].J Am Coll Cardiol,2012,59(7):673-680.
[2]Hensley N,Dietrich J,Nyhan D,et al.Hypertrophic cardiomyopathy:a review[J].Anesth Analg,2015,120(3):554-569.
[3]Notomi Y,Lysyansky P,Setser RM,et al.Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging[J].J Am Coll Cardiol,2005,45(12):2034-2041.
[4]韦玮,龚兰,肖俊飞,等.二维斑点追踪技术评价2型糖尿病患者左心房功能[J].医学研究杂志,2017,46(8):171-175.
[5]Saraiva RM,Demirkol S,Buakhamsri A,et al.Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function[J].J Am Soc Echocardiogr,2010,23(2):172-180.
[6]Domsik P,Kalapos A,Chadaide S,et al.Three-dimensional speckle tracking echocardiography allows detailed evaluation of left atrial function in hypertrophic cardiomyopathy-insights from the MAGYAR-Path Study[J].Echocardiography,2014,31(10):1245-1252.
[7]Ho SY,Anderson RH,Sáa nchez-Quintana D.Atrial structure and fibres:morphologic bases of atrial conduction[J].Cardiovasc Res,2002,54(2):325-336.
[8]王妍,何继强,高阅春,等.711例肥厚型心肌病患者临床特征分析[J].中国循环杂志,2011,26(6):434-437.
[9]Welles CC,Ku IA,Kwan DM,et al.Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease:longitudinal data from the Heart and Soul Study[J].J Am Coll Cardiol,2012,59(7):673-680.