实时三维超声心动图及三维斑点追踪技术评估左心室射血分数保留的多发性骨髓瘤患者左心房功能的价值

Evaluation of left atrial function in multiple myeloma patients with preserved left ventricular ejection fraction using real-time three-dimensional echocardiography and three-dimensional speckle tracking imaging

目的:采用三维斑点追踪成像技术(3D-STI)及实时三维超声心动图(RT-3DE)观察左心室射血分数(LVEF)正常的多发性骨髓瘤(MM)患者左心房功能变化及其影响因素。方法:选取2020年1-4月于华西医院就诊的LVEF值正常的MM患者48例(分为室壁正常组20例及室壁增厚组20例)及正常对照组32例。对所有受检者行常规超声心动图、RT-3DE及3D-STI分析。结果:(1)MM患者中室壁增厚组β2微球蛋白及游离轻链水平较高(P<0.05)。(2)与对照组相比,MM患者室壁增厚组及室壁正常组左心房被动射血分数(LAPEF)、左心房射血分数(LAEF)、左心房舒张早期应变(LA Se)及左心房收缩期峰值应变(LA Sg)均明显减低;与室壁正常组相比,室壁增厚组左心房容积指数(LAVi)升高,而左心房主动射血分数(LAAEF)、左心房舒张晚期应变(LA Sa)及LA Sg均明显减低(均P<0.05)。(3)MM患者游离轻链水平与LAAEF(r=-0.462,P<0.05)、LAEF(r=-0.457,P<0.05)、LA Sg(r=-0.523,P<0.05)、LA Se(r=-0.396,P<0.05)呈负相关,与LAVi(r=0.537,P<0.001)呈正相关。(4)多因素分析中,Lg_(游离轻链)(OR=20.514,95%CI:1.165~361.271,P=0.022)、Lg_(NT-pro BNP)(OR=12.488,95%CI:1.103~141.45,P=0.008)、LAEF(OR=0.641,95%CI:0.421~0.976,P<0.001)及LAVi(OR=1.313,95%CI:1.060~1.626,P=0.009)是LA Sg降低的危险因素。结论:LVEF值保留的MM患者左心房功能受损主要为储存及管道功能改变。左心房容积增加、储存及管道功能受损与游离轻链水平相关。

Objective:To observe the left atrial function in multiple myeloma(MM)patients with preserved left ventricular ejection fraction(LVEF)through three-dimensional speckle tracking imaging(3 D-STI)and real-time three-dimensional echocardiography(RT-3 DE).Methods:Forty-eight MM patients with preserved LVEF and 32 normal people(control group)in West China Hospital from January to April 2020 were selected.MM patients were divided into normal ventricular wall group(n=20)and thick ventricular wall group(n=20).All subjects were undergoing routine echocardiography,RT-3 DE and 3 D-STI.Results:Theβ2 microglobulin and free light chain levels were higher in the thick ventricular wall group(P<0.05).Compared with the control group,left atrial passive ejection fraction(LAPEF),left atrial ejection fraction(LAEF),left atrial early diastolic strain(LA Se),and left atrial systolic peak strain(LA Sg)were reduced in MM patients;Compared with the normal ventricular wall group,left atrial volume index(LAVi)were significantly increased in the thick ventricular wall group,whereas left atrial active ejection fraction(LAAEF),left atrial late diastolic strain(LA Sa),and LA Sg were significantly decreased(all P<0.05).The free light chain value was negatively correlated with LAAEF(r=-0.462,P<0.05),LAEF(r=-0.457,P<0.05),LA Sg(r=-0.523,P<0.05),and LA Se(r=-0.396,P<0.05),while was positively correlated with LAVi(r=0.537,P<0.001)in MM patients.Multivariate regression analysis showed that the Lg(free light chain)(OR=20.514,95%CI:1.165-361.271,P=0.022),Lg(NT-proBNP)(OR=12.488,95%CI:1.103-141.45,P=0.008),LAEF(OR=0.641,95%CI:0.421-0.976,P<0.001),and LAVi(OR=1.313,95%CI:1.060-1.626,P=0.009)were predictors for LA Sg reduction.Conclusion:The main impairment of left atrial function in MM patients with preserved LVEF is the change of saving and pipeline function.Increased left atrial volume,impaired saving and pipeline function are associated with free light chain levels.