应变率成像评估左心室不同舒张功能状态患者左心房功能

Evaluation on left atrial function in patients with left ventricular diastolic dysfunction by strain rate image

目的探讨应变率成像(SRI)评估左心室不同舒张功能状态下左心房功能的价值。方法128例受检者根据左心室不同舒张功能状态分成正常组、顺应性降低组、假性正常化组及限制性充盈障碍组。采集心尖四腔观、三腔观和二腔观组织速度图,SRI测量并计算左心室收缩期左心房平均峰值应变率(mSRs)、左心室舒张早期左心房平均值峰应变率(mSRe)、左心房收缩期左心房平均峰值应变率(mSRa);测量包括二尖瓣口舒张早期前向血流峰值速度(E)与二尖瓣前瓣环组织多普勒E比值(E/E′)及E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。将SRI所测左心房功能相关参数与反映左心室舒张功能相关参数作对比。结果E/Vp及E/E′随舒张功能障碍加重而增高,1.1±0.3 vs 1.6±0.2 vs 2.1±0.3 vs 2.6±0.4和7.4±2.4 vs 10.4±2.9 vs17.6±4.2 vs 22.8±4.8(均P<0.05);4组患者mSRs、mSRe、mSRa差异有统计学意义(P<0.05);mSRe随舒张功能障碍加重而降低,(3.73±0.92)s-1vs(2.84±0.54)s-1vs(1.94±0.23)s-1vs(1.85±0.30)s-1(均P<0.05),mSRs及mSRa在舒张功能降低组最高,而在限制性充盈障碍组中最低;E/E′、E/Vp与mSRe呈良好负相关(r=-0.813,P<0.01;r=-0.793,P<0.01)。结论SRI可准确评价左心室不同舒张功能状态患者左心房功能。

Objective To evaluate left atrial function with strain rate image （SRI） in paients with left ventricular diastolic dysfunction. Methods One hundred and twenty eight subjects were divided into four groups （normal, impaired relaxation,pseudonormal and restrictive） on the basis severity of diastolic function. Tissue Doppler image from apical four-chamber,three-chamber,and two chamber views were performed in all the patients. The mean atrial strain rate at each left atrial middle segment were measured and calculated during left ventricular systolic phase（mSRs）, left ventricular early diastolic phase（mSRe）,left atrial systolic phase（mSRa）. The parameters that reflect left ventricular diastolic function including 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. All left atrial function parameters measured by SRI were compared with left ventricular diastolic parameters. Results E/ E＇, E/Vp were increased with the severity of left ventricular diastolic dysfunction, 1.1±0.3 vs 1.6±0.2 vs 2.1±0.3 vs 2.6±0.4 and 7.4±2.4 vs 10.4±2.9 vs 17.6±4.2 vs 22.8±4.8（all P 〈0.05）. mSRs,mSRe,mSRa were different in the four groups（ P 〈 0.05）. mSRe decreased with the severity of left ventricular diastolic dysfunction, （3.73 ±0.92） s 1 vs （2.84±0.54） s 1 vs （1.94±0.23） s^-1 vs （1. 85±0. 30） s^-1（allP 〈0. 05）. mSRe was significantly negative correlated with E/E＇,E/Vp （ r =-0. 813, P 〈0.01; r =-0. 793, P 〈0.01）. mSRs and mSRa were the highest in diastolic function impaired group,and were the lowest in restrictive filling group mSRs and mSRa. Conclusion SRI can assess left atrial function in patients with different severity of left ventricular diastolic dysfunction.