实时三平面容积/应变率成像评价心肌梗死患者左心房整体及局部功能

Evaluation of left atrial global and regional functions in patients with myocardial infarction using real-time triplane echocardiography and triplane strain rate imaging

目的:应用实时三平面超声心动图(RT-3PE)和实时三平面应变率成像(Triplane-SRI)技术定量评价心肌梗死患者左心房整体及局部功能,探讨左心室功能的损害对左心房功能的影响。方法:A组为31例左心室射血分数(LVEF)≥50%的心肌梗死患者;B组为20例LVEF<50%的心肌梗死患者,C组为30例正常人。组织多普勒测量二尖瓣环收缩期峰值速度(Sa)、舒张早期峰值速度(Ea)和舒张晚期峰值速度(Aa)。脉冲多普勒测量二尖瓣口舒张早期峰值流速(E)、舒张晚期峰值流速(A)。RT-3PE软件获得左心房最大容积(LAVmax)、最小容积(LAVmin)、收缩前容积(LAVpre)、总排空分数(LAVt EF)、被动排空分数(LAVp EF)、主动排空分数(LAVa EF)等参数。Triplane-SRI软件获得左房前壁、侧壁、后壁、下壁和房间隔的心室收缩期、舒张早期和心房收缩期峰值应变率并计算其平均值(MSRS、MSRE和MSRA)。结果:1与C组比较,A、B两组Sa、Ea及Aa均显著减低(P<0.05),A组E峰显著减低(P<0.05),A峰显著增加(P<0.05),E<A;B组A峰明显减低(P<0.05),E>A。2与C组比较,B组LAVt EF、LAVp EF及LAVa EF均显著减低(均P<0.05),A组LAVt EF、LAVp EF显著减低(P<0.05),但LAVa EF减低不显著。3与C组比较,B组各左心房壁及房间隔MSRS、MSRE及MSRA均显著减低(均P<0.05),A组各左心房壁及房间隔MSRS、MSRE均显著减低(均P<0.05),但左心房侧壁、后壁及下壁MSRA减低不显著。结论:RT-3PE和Triplane-SRI能从左心房容积和心房肌形变的角度综合评价左心房功能。

AIM： To evaluate the left atrial global and regional functions in patients with myocardial infarction （MI） using real-time triplane echocardiography （RT-3PE） and triplane strain rate imaging （triplane-SRI）. METHODS： Thirty one MI patients with left ventricular ejection fraction （LVEF）≥ 50% （group A）, 20 MI patients with LVEF 〈 50% （group B） and 30 normal controls （group C ） were examined by RT-3PE and triplane-SRI. Peak velocities of mitral annulus were measured during the phase of systole （ Sa）, the early phase of diastole （Ea） and the late phase of diastole （Aa） by tissue Doppler. The transmitral peak rapid filling velocity （E） and peak atrial filling velocity （A） were measured by pulse Doppler. Left atrium maximal volume （LAVmax）, left atrium minimal volume （LAVmin）, left atrium presystolic volume （LAVpre）, left atrium total emptying fraction （LAVtEF）, left atrium passive emptying fraction （LAVpEF） and left atrium active emptying fraction （LAVaEF） were measured using RT-3PE software. Mean systolic peak strain rate （MSRS）, mean early diastolic peak strain rate （MSRE） and mean late diastolic peak strain rate （MSRA） of left atrial anterior, lateral, posterior, inferior and septum sites were measured with triplane-SRI software. RF-ULTS： Compared with those in group C, Sa, Ea and Aa in group A and B all decreased significantly （P 〈0. 05）. E decreased significantly （P 〈 0. 05）, A increased significantly （P 〈 0. 05）, and E 〈 A in group A, whereas A decreased significantly （P 〈 0. 05） and E 〉 A in group B. Compared with those in group C, LAVtEF, LAVpEF and LAVaEF in group B and LAVtEF and LAVpEF in group A all decreased significantly （P 〈 0. 05 ）, whereas no significant difference in LAVaEF was found in group A （P 〉0. 05）. Compared with those in group C, MSRS, MSRE and MSRA in group B and MSRS and MSRE in group A decreased significantly （P 〈 0. 05 ）, whereas no significant difference in MSRA of left atrial ateral, posterior and inferior was found in group A. CONCLUSION ： RT-3PE and triplane-SRI can comprehensively evaluate left atrial global and regional functions and booster pump of left atrium reflects the degree of left ventricular dysfunction to some extent.