慢性心力衰竭患者左心房功能和不同步性的初步研究

Evaluation of function and asynchronization of left atrial in chronic heart failure patients

目的运用实时三维超声心动图（RT-3DE）技术定量评价慢性心力衰竭患者左心房容积和功能,并对其不同步性作初步研究。方法选择30例健康受试者和32例慢性心力衰竭患者,分为对照组和心力衰竭组。心力衰竭组：男性18例,女性14例;年龄42~65岁,平均年龄58岁。对照组：男性17例,女性13例;年龄45~60岁,平均年龄54岁。用RT-3DE进行左心房时间-容积曲线分析,获取容积指标：最大容积（LAVmax）、最小容积（LAVmin）、主动收缩前容积（LAVp）,计算左心房总射血分数（LATEF）、被动射血分数（LAPEF）及主动射血分数（LAAEF）。同时获得左心房不同步性参数：达最小容积时间标准差Tmsv-16-SD、Tmsv-12-SD、Tmsv-6-SD和最大时间差Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif。容积指标用体表面积进行标化,时间参数用R-R间期校正。并分析校正后的不同步性指标Tmsv-16-SD%、Tmsv-16-Dif%与容积指数LAVmaxI等的相关性。结果①各容积指标校正前后,心力衰竭患者左心房容积均增大,左心房射血分数LATEF、LAPEF和LAAEF均减小,差异有显著统计学意义（P〈0.01）。②不同步性指标Tmsv-16-SD%、Tmsv-16-Dif%等在心力衰竭组增大,差异均有显著统计学意义（P〈0.01）。③Tmsv-16-SD%、Tmsv-16-Dif%与各容积指数呈正相关关系,与各射血分数呈负相关关系,其中与LAVmaxI相关性最强,r分别为0.73、0.75（均为P〈0.01）。结论慢性心力衰竭患者左心房功能减低,存在着不同步性。RT-3DE可以较好地评价左心房功能和不同步性。

Objective To evaluate the volume and function of left atrial in patients with chronic heart failure（CHF） by real time-three-dimensional echocardiography（RT-3DE）,and assess its asynchronization.Methods A total of 30 healthy controls and 32 CHF patients were enrolled,which divided into control group and CHF group.There were 18 males and 14 females in CHF group,mean age 58 years old（range 42-65 years old）.There were 17 males and 13 females in control group,mean age 54 years old（range 45-60 years old）.From time-volume curve of left atrial analyzed by RT-3DE workstation,the volume parameters were acquired as followed： the maximum volume of left atrial（LAVmax）,minimum volume of left atrial（LAVmin） and volume before contraction of left atria（LAVp）.Accordingly,the total ejection fraction of left atrial（LATEF）,the passive ejection fraction of left atrial（LAPEF） and the active ejection fraction of left atrial（LAAEF） were calculated.The asynchronization parameters derived from RT-3DE were dispersion and maximum difference of time to minimum volume（e.g.Tmsv-16-SD,Tmsv-12-SD,Tmsv-6-SD,Tmsv-16-Dif,Tmsv-12-Dif and Tmsv-6-Dif）.The index of volume and time were corrected by body surface area and interval of R-R respectively,and the correction of Tmsv-16-SD %,Tmsv-16-Dif % and LAVmaxI were analyzed.Results ①All index of volume before and after correction were gradually increased from control group to CHF group,but the LATEF,LAPEF and LAAEF were reversed,and all of parameters had significant difference between 2 groups（P 0.01）.②The asynchronization parameters in CHF group were significantly higher than that of control group（P 0.01）.③The Tmsv-16-SD % and Tmsv-16-Dif % showed a positive correlation with volume index,and a negative correlation with ejection fraction.The most significantly correlation parameters was LAVmaxI,with r = 0.73 and 0.75（P 0.01）.Conclusion It is demonstrated that the function of left atrial are reduced in CHF patients,there exist asynchronization.The RT-3DE may play important role in the evaluation of function and asynchronization of left atria.