左心室不同舒张功能状态左心房几何重构的初步研究

摘要

Objective To evaluate left atrial geometry remodeling in patients with left ventricular diastolic dysfunction. Methods One hundred and seventy-three patients were divided into four groups by left ventricular diastolic dysfunction grade : normal group( 37 subjects ) , impaired relaxation group( 76 subjects ), pseudonormal group( 26 subjects ),restrictive group( 34 subjects ). Left atrial eccentricity index( LAEI )was measured by two-dimensional echocardiography to describe left atrial geometry remodeling. 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 measured.Results LAEI decreased , E/E' and E/Vp increased with severity of left ventricular diastolic dysfunction grade( P ＜0. 05 ).LAEI were significantly negatively related with E/E' and E/Vp( r = -0. 73 ,P ＜0. 05 ;r = -0. 69 ,P ＜0. 05 ). LAEI ＜ 1. 275 had a sensitivity of 83. 8％ and a specificity of 71.40％ for discriminate pseudonormal from normal. Conclusion Left atrial geometry remodeling had intently relation with left ventricular diastolic dysfunction. LAEI may be a sensitive reference index for patients with left ventricular diastolic dysfunction in clinic use.%目的 探讨左心室不同舒张功能状态患者左心房几何重构.方法 173例患者根据左心室舒张充盈状态分级分为4组(正常组37例,舒张功能降低组76例,假性正常化组26例,限制性充盈障碍组34例),应用二维超声测量左心房偏心指数(LAEI)评价左房几何重构;测量包括二尖瓣口舒张期前向峰值血流速度(E峰)与二尖瓣前瓣环组织多普勒舒张期前向运动速度E'峰比值(E/E')、二尖瓣口E峰与二尖瓣口M型彩色多普勒峰值血流速度Vp比值(E/Vp)等左心室舒张功能相关参数.结果 随着左室舒张充盈状态分级的增加,LAEI逐渐降低,而E/ E'、E/Vp增大(P＜0.05);LAEI与E/ E'、E/Vp均呈负相关(r=-0.73,P＜0.05;r=-0.69,P＜0.05);LAEI＜1.275辨别假性正常化敏感度和特异度分别为83.8%、71.4%.结论 左心房几何重构与左心室舒张充盈状态密切相关,LAEI指数可作为临床评价左心室舒张充盈状态的敏感参考指标.