二维斑点追踪显像和实时三维超声心动图对慢性心力衰竭患者左心房功能和同步性的研究

Evaluation of the function and synchronization of left atrial in chronic heart failure patients by two dimensional-speckle tracking imaging and real-time three-dimensional echocardiography

目的应用二维斑点追踪显像（2D-STI）和实时三维超声心动图（RT-3DE）定量评价正常人及慢性心力衰竭患者的左房功能和同步性，并进行对比研究。方法先采用2D-STI对32例正常人和29例慢性心力衰竭患者进行心肌应变曲线分析，得出左房各房壁三节段平均应变（roSs、mSe和mSa）及应变率（mSRs、mSRe和mSRa），计算此时的同步性指标所有节段从QRS波起点到应变达峰时间的标准差（T—SD）。再应用RT-3DE对上述受检者进行容积-时间曲线分析，获得左房容积指标：最大容积（LAVmax）、最小容积（LAVmin）、收缩前容积（LAVp），计算左房总的射血分数（LATEF）、被动射血分数（LAPEF）、主动射血分数（LAAEF），并获取左房同步性参数-达左房最小容积时间的标准差（Tmsv-16-SD）。容积指标用体表面积标化，时间参数用心电图R-R间期校正。并分析校正后的同步性指标T—SD％和Tmsv-16-SD％与应变率、容积指数和左房射血分数之间的相关性。结果①心力衰竭组左房平均应变较对照组减小，应变率减低，差异有统计学意义（P〈0．05）。②与对照组相比，心力衰竭组左房容积指数均增大，各射血分数均降低，差异有统计学意义（P〈0．05）。③两种技术测量的同步性指标心力衰竭组均较对照组增加，差异有统计学意义（P〈0．05）。与2D-STI相比，RT-3DE测得的同步性指标值偏大，不同步率较高。④同步性指标与应变率和左房射血分数呈负相关，与左房容积指数呈正相关。结论慢性心力衰竭时左房增大，功能降低，心房肌运动不同步。2D-STI和RT-3DE均可评价左房功能和同步性，RT-3DE对左房不同步检出率较高。

Objective To evaluate the function and synchronization of left atrial in patients with chronic heart failure（CHF） by two dimensional-speckle tracking imaging（2D-STI） and real-time three- dimensional echocardiography（RT-3DE）. Methods Thirty-two healthy controls and twenty-nine patients with CHF were studied. The mean strain and strain rate during systole, early and late of diastole（roSs, mSe and rosa, mSRs, mSRe and mSRa） were measured at each left atrial wall by 2D-STI. From the volume-time curve of RT-3DE workstation, the maximum volume （LAVmax）, the minimum volume（LAVmin）, the volume before contraction （LAVp） of left atrial were acquired. Accordingly, the total, passive and active ejection fraction could be calculated. The synchronization parameters derived from 2D-STI and RT-3DE were the dispersion of time to peak strain and time to the minimum volume （T-SD and Tmsv-16-SD）. The index of volume and time were corrected by the body surface area and interval of R-R, respectively. The correlation were analysed betwee them. Results （1） Comparing between two groups, the roSs, mSe and rosa were shortened and the mSRs, mSRe and mSRa were slower in CHF group （ P 〈0.05）. （2） All the index of volume were gradually increasing from control to CHF group,but the LATEF,LAPEF and LAAEF were just the reverse, with all parameters had significant difference between two groups （P 〈 0.05）. （3）The synchronization parameters were significantly higher from control to CHF group by the two kinds of skills （P 〈0.05）. Comparing with 2D-STI, the indexes of synchronization were bigger and the asynchronization rate of CHF group were higher by RT 3DE. （4）The indexes of synchronization had a negative correlation with the strain rate and the ejection fraction, but had a positive correlation with the index of volume. Conclusions The function of left atrial are reduced in patients of CHF, there are asynchronization. 2ISSTI and RT-3DE may paly important roles in the evaluation of function and synchronization of left atrial. The relevance ratio of the left atrial asynchronization are higher from the RT-3DE than 2D-STL