实时三维超声心动图检测冠心病左房容量与功能的探讨

Measurement of left atrial volume and function in coronary heart disease with real-time three-dimensional echocardiography

目的:探讨实时三维超声技术(RT-3DE)检测冠心病患者左房容量与功能的准确性及其应用价值。方法:选择冠心病患者28例为观察组,正常对照者30例为对照组,应用电影磁共振(cine-MRI)、RT-3DE和二维超声心动图(2DE)测量观察组左房最大容量(LAVmax)、最小容量(LAVmin)、主动收缩前容量(LAVbs)、主动收缩排血量(LASV)、主动收缩射血分数(LAEF);应用RT-3DE测量对照组LAVmax、LAVmin、LAVbs、LASV、LAEF;应用脉冲多普勒技术测量两组舒张期二尖瓣口血流频谱,测定舒张早期峰值流速(E)、E峰减速时间(EDT)、舒张晚期峰值流速(A),E/A比值。比较观察组与对照组间或观察组不同检测方法间的测量结果。结果:观察组RT-3DE测值同cine-MRI相应测值比较,差异无统计学意义(P>0.05);2DE测值明显低于cine-MRI测值(P<0.05)。观察组RT-3DE测值同cine-MRI测值呈良好相关(r=0.87～0.94)。观察组RT-3DE测得的LAEF同脉冲多普勒所测的EDT呈高度正相关(r=0.87),同E/A比值呈高度负相关(r=-0.85),2DE测得的LAEF同脉冲多普勒所测的EDT呈中度正相关(r=0.67),同E/A比值呈中度负相关(r=-0.72),两者差异具有统计学意义(P<0.05)。结论:RT-3DE测定左房容量与功能准确可靠,测得的左房功能参数能准确反映冠心病左室舒张功能受损的程度。RT-3DE为观察冠心病左房容量与功能的变化提供了新的检测方法。

Objective： To evaluate the accuracy and value of real-time three-dimensional echocardiography in measurement of left atrial volume and function in coronary heart disease. Methods： The maximum left atrial volume （LAVmax）, minimum left atrial volume （LAVmin）, left atrial volume before systole （LAVbs）, left atrial systolic volume （LASV）, left atrial ejection fraction（LAEF） were measured with MRI, real-time three-dimensional echocardiography （RT-3DE） and two-dimensional echocardiography （2DE） in coronary heart disease group（n = 28）; were measured with RT-3DE in control group （n = 30）. The velocity of E wave（E）, A wave （A）, the deceleration time of the E wave （EDT） and E/A ratio in diastolic mitral valve flow graph were measured with plused Doppler echocardiography in both groups. The different results between two groups or among different methods were compared. Results： The values of LAVmax, LAVmin, LAVbs, LASV and LAEF were not significantly different between RT-3DE and cine-MRI （P ＞ 0.05）; significantly lower with 2DE than with cine-MRI （P ＜ 0.05）; high related in RT-3DE and cine-MRl（r = 0.87～0.94）. The value of LAEF obtained with RT-3DE had a positive relation with that with EDT （r = 0.87）and a negative relation with E/A ratio （r = -0.85） obtained with plused Doppler echocardiography. Conclusion： The left atrial volume and function can be measured accurately and reliably with RT-3DE and can correctly reflect the left ventricular diastolic dysfunction in coronary heart disease. RT-3DE provides a new method of observing left atrial volumes and functions and evaluating more comprehensively and accurately the left ventricular diastolic dysfunction in coronary heart disease.