二维斑点追踪技术评价不同程度左室舒张功能减低患者左房收缩运动同步性的研究

摘要

Objective To evaluate left atrial systolic synchrony in patients with different left ventricular diastolic function patterns using two-dimensional speckle tracking echocardiography. Methods Fifty-three patients with diastolic disfunction of different levels and 39 patients with normal diastolic function and volunteers were enrolled. According to the international guidance about evaluation of left ventricular diastolic function published in 2009,92 cases were divided into four groups including:normal group(39 cases),impaired relaxation group(30 cases),pseudonormal group(15 cases) and restrictive filling pattern group(8 cases). The longitudinal strain curves of left atrial twelve segments in 2-chamber and 4-chamber views were generated using two-dimensional speckle tracking echocardiography. Mean time standard deviation of atrial systole(MTSD) was calculated. Differences of MTSD among the groups were compared . Correlation analysis of MTSD with left atrial volume index(LAVI) was performed. Results There was no significant difference in MTSD between nomal group and impaired relaxation group. There was significant difference in MTSD between the rest two groups(P<0.05).From pseudonormal group to restrictive filling pattern group,MTSD gradually increased comparing with the normal group and impaired relaxation group. Correlation analysis showed MTSD and LAVI were significant correlated(r=0.70,P<0.01). Conclusion Two-dimensional speckle tracking echocardiography can be used for evaluating left atrial myocardial systolic synchrony. With gradually reduced left ventricular diastolic function,the synchrony of left atrial segmental systolic movement presents the process of at first smooth and then,with increased left atrial volume,gradual decline.%目的 应用二维斑点追踪技术评价不同程度左室舒张功能减低患者左房收缩运动同步性.方法 选取我院53例不同程度左室舒张功能减低的患者、39例舒张功能正常的患者及志愿者作为研究对象,根据2009年关于左室舒张功能评估的国际指南将其分为正常组39例、松弛受损组30例、假性正常化组15例及限制性充盈状态组8例.应用二维斑点追踪技术获取左房两个切面共计12个节段的纵向应变曲线,计算左房12个节段到达心房收缩期最低应变值的平均时间标准差(MTSD)并进行各组间比较;分析MTSD与左房容积指数(LAVI)之间的关系.结果 正常组与舒张受损组MTSD比较差异无统计学意义,其余各组间MTSD比较差异均有统计学意义(均P<0.05),且从假性正常化组到限制性充盈状态组MTSD值相对于正常组及松弛受损组逐渐增大.相关性分析显示MTSD与LAVI显著相关(r=0.70,P<0.01).结论 二维斑点追踪技术可用于评价左房心肌收缩运动的同步性.随着左室舒张功能逐渐降低,左房各节段收缩运动同步性起初平稳,后随着左房逐渐增大,呈下降趋势.