二维斑点追踪显像和实时三维成像技术评价高血压病患者左心房功能

摘要

Objective To evaluate left atrial(LA) function in essential hypertensive patients by speckle tracking imaging (STI) and real-time three-dimensional echocardiography (RT-3DE).Methods Thirty seven patients with essential hypertension were divided into normal geometric left ventricle(LV) group (LVN, n = 17) and remodeling geometrc LV group (LVR,n = 20).Twenty-six healthy participants were also include.The strain rate curve was auquired in each LA segment (anterior, posterior, lateral, inferior and septal) by STI. The LV mass, LA maximal, minimal and pre-systolic volume (LAVmax, LAVmin and LAVp), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF) were measured by RT-3DE. Results ①Compared with the control group, the mean peak systolic strain rate(mSR_S) in LVN group was lower(P <0.05), and the mSR_S, mean peak early diastolic strain rate(mSR_E) in LVR group were reduced (P <0.01, P<0.05), and the mean peak late diastolic strain rate (mSR_A) in LVR group was increased (P<0.01).②Compared with the control group,the LAVmax, LAVmin and LAV_P all increased in LVN and LVR group(P <0.05 or P <0, 01), the LAPEF was degraded (P<0.05),and the LAAEF was increased (P<0.05) in the LVR group.③A significant relation between mSR_E and LAPEF(r = 0.788, P <0.01), mSR_A and LAAEF(r = 0.804, P<0.01) could be found in the LVN and LVR group. Conclusions STI and RT-3DE may play important roles in the evaluation of left atrial function. The deformation ability of LA wall may decrease before left ventricular remodeling and it showed a significantly positive correlation with LA ejection function in patients with essential hypertension.%目的 应用二维斑点追踪显像(STI)和实时三维超声心动图(RT-3DE)技术测量高血压病患者左房应变率及左房容积的变化,评价其功能.方法 对37例高血压病患者[左窀正常构型(LVN)组17例和左室重构(LVR)组20例]与26例健康自愿者对照组,应用STI技术获取左房前壁、后壁、侧壁、下壁、房间隔的的应变率曲线;应用RT-3DE计算左室质量、左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房收缩前容积(LAVp)、左房被动射血分数(LAPEF)和左房主动射血分数(LAAEF).结果 ①与对照组比较,LVN组左室收缩期的左房平均峰值应变率(mSR_S)显著降低(P<0.05),LVR组的mSR_S及左室舒张早期的左房平均峰值应变率(mSR_E)亦显著降低(P<0.01,P<0.05),左室舒张晚期的左房平均峰值心变率(mSR_A)显著升高(P<0.01);②与对照组比较,LVN组和LVR组的LAVmax、LAVmin、LAV_P均显著升高(P<0.05或P<0.01),LVR组的LAPEF显著减低(P<0.05),LAAEF显著升高(P<0.05);③LVN组及LVR组的mSR_E与LAPEF、mSR_A与LAAEF相关性良好(分别r=0.788,P<0.01;r=0.804,P<0.001).结论 二维斑点追踪显像技术和实时三维成像技术可以评价高血压患者的左房功能;高血压病患者左室重构发生前其左房壁形变能力已降低;高血压病患者寿房壁形变能力与左房射血功能显著正相关.