左心房容积追踪技术评价成人继发孔型房间隔缺损伴肺动脉高压的左心房大小和功能

Evaluation of Left Atrial Size and Function in Adults with Secundum Atrial Septal Defect Combined with Pulmonary Arterial Hypertension Using Left Atrial Volume Tracking Method

目的探讨左心房容积追踪(LAVT)技术对成人继发孔型房间隔缺损(S-ASD)伴轻、中度肺动脉高压患者的左心房大小及功能的评价。资料与方法 34例S-ASD患者为S-ASD组,36例健康成人为对照组。应用LAVT技术获得左心房容积-时间曲线和容积变化速率曲线,记录左心房容积-时间曲线上的左心房最大容积(LAVmax)、左心房收缩前容积(LAVpre)、左心房最小容积(LAVmin),用体表面积校正后得到相应的LAVImax、LAVIpre、LAVImin,并计算左心房整体排空量(LAVItotal)、左心房被动排空量(LAVIpass)、左心房主动排空量(LAVIact)、左心房整体排空分数(LAVItEF)、左心房被动排空分数(LAVIpEF)、左心房主动排空分数(LAVIaEF)。记录左心房容积变化速率曲线上收缩期左心房的充盈速率峰值(dv/dtS)、舒张早期排空速率峰值(dv/dtE)、舒张晚期排空速率峰值(dv/dtA)。结果与对照组相比,S-ASD组左心房内径(LA)、LAVImax、LAVIpre、LAVImin明显增大,差异有统计学意义(t=2.987、4.196、3.836、4.478,P<0.05),LAVItEF、dv/dtS、LAVIaEF、dv/dtA明显减小,差异有统计学意义(t=-2.400、-2.481、-2.171、2.506,P<0.05),LAVItotal、LAVIpass、LAVIact、LAVIpEF、dv/dtE差异无统计学意义(t=2.029、1.984、1.883、-1.628、-0.815,P>0.05)。结论 S-ASD伴轻、中度肺动脉高压的左心房大小及容积增大,助力泵功能、储存功能降低,管道功能未发生明显改变。LAVT技术能够准确、快速地评价S-ASD左心房的大小和功能变化,为临床提供有价值的信息。

Purpose To evaluate the left atrial size and function in adults with secundum atrial septal defect （S-ASD） combined with mild or moderate pulmonary arterial hypertension by employing left atrial volume tracking method （LAVT）. Materials and Methods Thirty-four S-ASD patients with mild or moderate pulmonary arterial hypertension as S-ASD group and 36 healthy adults as control group were enrolled in the study. Left atrial volume （LAV）-time curve and volume change rate curve were drawn by using LAVT; maximal LAV （LAVmax）, LAV before contraction （LAVpre） and minimal LAV （LAVmin） were recorded in the LAV-time curve and the corresponding indexes such as LAVImax, LAVIpre, LAVImin were further obtained after correction by body surface area, then LAVItotal, LAVIpass, LAVIact, LAVItEF, LAVIpEF, LAVIaEF were calculated. Besides, left artiral dv/dtS, dv/dtE and dv/dtA were measured in the left artial volume change velocity curve. Results Compared with control group, S-ASD group had increased LA internal diameter, LAVImax, LAVIpre and LAVImin （differences with statistical significance, t=2.987, 4.196, 3.836 and 4.478, P〈0.05）, and had reduced LAVItEF, dv/dtS, LAVIaEF and dv/dtA （differences with statistical significance, t= - 2.400, - 2.481, - 2.171 and 2.506, P〈0.05）. There were no significant differences in LAVItotal, LAVIpass, LAVIact, LAVIpEF, dv/dtE between the two groups （t=2.029, 1.984, 1.883, - 1.628 and - 0.815, P〉0.05）. Conclusion Patients with S-ASD combined with mild or moderate pulmonary arterial hypertension seem to have enlarged left atrial size and volume. Their atrial booster pump function and storage function deteriorate, but the passage function does not show any obvious change. LAVT method can fast evaluate changes of left atrial size and volume in S-ASD patients, so that it provides useful information for clinical treatment.