组织多普勒成像评价冠心病患者左心房功能的临床研究

Assessment of left atrial function in patients with coronary heart disease by tissue Doppler imaging

目的应用组织多普勒超声技术(TDI)检测冠心病患者左心房功能,评价左心房功能与冠脉病变程度的关系,并观察经皮冠状动脉介入治疗术(PCI)后冠心病患者左心房功能的变化。方法研究对象共200例,其中160例为疑诊冠心病,接受冠状动脉造影术或PCI治疗的患者,根据冠脉造影结果,分为动脉粥样硬化组和冠心病组,并按照Gensini积分分为4组,对所有研究对象行左心房功能常规超声指标测量并利用TDI测量左心房侧壁运动的峰值速度(Va)及左心房收缩起始时间(To)、达峰时间(Tp)、终止时间(Te)。行PCI术患者于术后3 d、1个月复查以上指标。选取40例正常人作为对照组。结果①与正常组相比,动脉粥样硬化组常规超声指标无统计学差异(P>0.05),冠心病组左心房内侧横径、面积、容积增大,面积排空分数、容积排空分数下降,二尖瓣血流E/A减低(P<0.05);②随着Gensini积分的增加,Va值下降(P<0.05),To、Tp、Te值增加(P<0.05);③与术前相比,冠心病患者PCI术后3 d左心房功能有所改善,但无显著差异(P>0.05);术后1个月,左心房内侧横径、面积、容积减小,面积排空分数、容积排空分数增加,Va值上升、To、Tp、Te值减小,E/A增加(P<0.05)。结论利用组织多普勒成像技术可以客观准确地评价冠心病患者左心房功能;左心房功能与冠脉病变程度有良好的相关性,随着冠脉病变程度加重,左心房功能逐渐减低;PCI术可以改善冠心病患者的左心房功能。

Objective To evaluate the left atrial function and its changes after percutaneous coronary intervention（PCI） in patients with coronary heart disease（CAD） by tissue Doppler imaging（TDI）.Methods Two hundred subjects were selected in this study.One hundred and sixty patients who had taken the coronary angiography were divided into coronary atherosclerosis group and coronary artery disease group.They were further divided into 4 groups according to Gensini score.All the subjects received the conventional echocardiography and TDI was used to measure peak velocity（Va）,onset time（To）,peak time （Tp） and end time（Te）.The patients who were treated with PCI again received such examinations in 3 days and one month.Forty healthy subjects were chosen as normal control group.Results The echocardiography parameters of the patients showed no statistical significance in two groups（P〉0.05）.Compared with the normal control group,the atrial diameters,area and volume of the coronary atherosclerosis group were higher while the area emptying fraction,volume emptying fraction and atrial flow E/A were lower（P〈0.05）.With the increase of Gensini score,the Va value decreased（P〈0.05） and the values of To,Tp and Te increased（P〈0.05）.Compared with what it was before surgery,the left atrial function of patients had insignificant improvement 3 days after the PCI treatment（P〉0.05）.One month after surgery,the left atrial diameters,area,volume decreased.Area emptying fraction and volume emptying fraction increased.Va value and E/A increased while the values of To,Tp,and Te decreased（P〈0.05）.Conclusion The evaluation of the left atrial function in patients with CHD by TDI is objective and accurate.The left atrial function is well correlated with the lesion of coronary artery stenosis.PCI can greatly improve the left atrial function in patients with CHD.