左心房追踪技术评价高血压患者左心房功能变化的初步研究

Evaluation of the changes of left atrial function in patients with hypertension by left atrial volume tracking method

目的探讨左房追踪技术评价高血压患者左心房功能变化的临床应用价值。方法31例高血压患者及31例正常人，获取心尖动态两腔观及四腔观图像。应用左房追踪技术获取左房最大容积（LAVmax）、最小容积（LAVmin）、收缩前容积（LAVpre）、收缩期左房充盈速率峰值（dv／dtS）、舒张早期左房排空速率峰值（dv／dtE）及舒张晚期左房排空速率峰值（dv／dtA）；计算左房被动排空容积（LAVp）、左房被动排空分数（LAVpEF）、左房主动排空容积（LAVa）、左房主动排空分数（LAVaEF）、左房总排空容积（LAVt）、左房总排空分数（LAVtEF）。所有左房容积指标均经体表面积校正得到左房容积指数（LAVI）。结果高血压患者与正常对照组比较，LAVImax、LAVImin、LAVIpre、LAVpEF、LAVIa、LAVIt、dv／dtS、dv／dtA差异均具有统计学意义（P〈0．05～0．001）；LAVp、LAVaEF、LAVtEF、dv／dtE两组间差异无统计学意义。LAVImax与LAVIp、LAVIa、LAVIt呈正相关（r=0．588～0．812，P均〈0．001）；LAVtEF与LAVaEF呈显著正相关（r=0．833，P〈0．001），而与LAVpEF相关性较弱（r=0．420，P〈0．01）；LAVImax与LAVIpre（r=0．908，P〈0．001）、LAVIpre与LAVIa（r=0．683，P〈0．001）、dv／dtE与LAVIp（r=0．690，P〈0．001）、dv／dtA与LAVIa（r=0．600，P〈0．001）均呈正相关。结论高血压患者左房存储器功能及泵功能增加，管道功能减低；左房追踪技术有望成为评价左房功能的新方法。

Objective To probe into the clinical value of left atrial （LA） volme tracking method （LAVT） on the assessment of left atrial function in patients with hypertension. Methods Thirty-one patients with hypertension and 31 control subjects were involved. Images of apical two-chamber and four- chamber views were obtained by two-dimensional echocardiography. LA maximal volume（LAVmax）, LA minimal volume （ LAVmin）, LA presystolic volume （ LAVpre）, systolic LA filling rate （ dv/dtS）, early diastolic LA emptying rate（dv/dtE） and late diastolic LA emptying rate （dv/dtA） were derived using LAVT. LA passive emptying volume（LAVp）, LA passive emptying fraction（LAVpEF）, LA active emptying volume（LAVa）, LA active emptying fraction（LAVaEF）, LA total emptying volume（LAVt）, LA total emptying fraction（LAVtEF） were calculated. All volume measurements were corrected to body surface area （LAVI）. Results There were significant differences in the LAVImax, LAVImin, LAVIpre, LAVpEF, LAVIa,LAVIt,dv/dtS,dv/dtA between hypertensive patients and control subjects（ P 〈0.05-0. 001 ）,but no significant differences were found in the LAVp, LAVaEF, LAVtEF, dv/dtE between the two groups. The LAVImax has shown significant positive correlation with LAVIp,LAVIa and LAVIt（ r = 0. 588-0. 812, P 〈0. 001）. LAVaEF has shown positive correlation with the LAVtEF（ r = 0. 833, P 〈0. 001 ）, whereas LAVpEF has not（ r = 0. 420, P 〈0.01）. There was a significant positive correlation with LAVImax and LAVIpre（ r = 0. 908, P 〈0. 001）,LAVIpre and LAVIa（ r = 0. 689, P〈0. 001）,dv/dtE and LAVIp（ r = 0. 690, P 〈0. 001 ）, dv/dtA and LAVIa（ r = 0. 600, P 〈0. 001 ）. Conclusions In hypertensive patients,left atrial reservoir function and booster pump function increase, while left atrial conduit function decreases. LAVT has a potential ability to evaluate left atrial function.