不同左心室舒张功能状态的冠心病患者左心房容积与功能研究

Assessment of the left atrial function and volumetric parameters in patients with coronary artery diseases

目的应用实时三维超声心动图（RT-3DE）评估左心室不同舒张功能状态的冠心病患者左心房容积与功能并探讨三维测量的左心房参数与左心室舒张功能分级的关系。方法80例冠心病患者根据左心室不同舒张功能状态分成舒张功能正常组、松弛功能降低组、假性正常化组及限制性充盈障碍组，各20例。比较4组左心房最大容积（LAVmax）、左心房收缩前容积（LAVpre）、左心房最小容积（LAVmin），体表面积校正后得出LAVmax指数、LAVpre指数、LAVmin指数，计算左心房总排空分数（LAVtEF）、左心房被动排空分数（LAVpEF）、左心房主动排空分数（LAVaEF）。结果在左心室舒张功能异常各组中，二尖瓣频谱的二尖瓣血流舒张早期速度峰值E／心房收缩期速度峰值（A）、E／二尖瓣环舒张早期峰值速度（Em）、E／左心室舒张早期血流传播速度（Vp）随着舒张功能障碍加重而增加，而E峰减速时间（DT）随着舒张功能障碍加重而降低（均P〈0．05）；LAVmax、LAVpre、LAVmin、LAVmax指数、LAVpre指数、LAVmin指数随舒张功能降低而增加，LAVtEF随舒张功能降低而降低（P〈0．05）；E／Em、E／Vp、DT与RT-3DE测量LAVmax指数、LAVpre指数、LVAmin指数、LAVtEF显著相关（r=0．75、0．70、0．73、-0．79；r=0．75、0．68、0．72、-0．83；r=-0．70、-0．69、-0．67、0．74，均P〈0．05）。LAVmax指数≥34ml／m^2，LAVtEF≤30％诊断左心室充盈压增高（即E／Em〉15），其敏感度和特异度分别为85．7％、65．6％及85．1％、81．6％。结论RT-3DE测量左心房容积与功能各项参数有助于临床更准确地评价左心室舒张功能。

Objective To evaluate left atrial （LA） function and LA volumetric parameters in patients with coronary artery diseases （CAD） by real-time three-dimensional echocardiography （RT-3DE）. And to assess the relationship between left ventricular（LV） diastolic function and LA parameters by RT-3DE. Methods Eighty patients with CAD were divided into four groups： the normal, the impaired relaxation, the pseudonormal and the rest rictive filling groups. All patients underwent three dimensional echocardiography to measure the LA maximum volume, LA volume pre contraction, left atrial minimum volume and the indices of LAVmax, LAVpre and LAVmin adjusted by surface area. Then LAVtEF, LAVpEF, LAVaEF were calculated. The peak flow velocities during early diastole （E）, atrial contraction （A）, E/A ratio were recorded and calculated by two-dimensional echocardiography （2DE）. The early peak of diastolic velocity of mitral annular velocity（ Em）, drag acceleration time of E and the early left ventricular diastole propagation velocity（Vp） were measured by tissue Doppler imaging. The results by 2DE and RT-3DE of all patients were respectively compared. Results There were increasing in E/A, E/Em, and E/Vp and decreasing in DT with increasing in the grading of the LV diastolic function （ all P 〈 0.05 ）. There were increasing in LAVmax, LAVpre, LAVmin, LAVmax index, LAVpre index, LAVmin index and decreasing in LAVtEF with increasing in the grading of the LV diastolic function（P 〈 0.05）. The E/Em, E/Vp, DT well correlated to LAVmax index, LAVpre index, LVAmin index, LAVtEF by RT-3DE, r was 0.75, 0.70, 0.73, - 0.79, respectively （all P 〈 0.05） and 0. 75, 0.68, 0.72, - 0.83, respectively （all P 〈 0.05） and - 0.70, - 0.69, - 0.67, 0.74, respectively （all P 〈 0. 05）. LAVmax index ≥34 ml/m^2, LAVtEF ≤30% could diagnose high left rentricular filling pressure （E/Em 〉 15）, the sensitivity and specificity were 85.7% , 65.6% and 85.1% , 81.6% respectively. Conclusion The indices of LA volume and function by RT-3DE in patients with CAD may have great value for assessing the left ventricular diastolic function.