左心房容积指数与稳定型心绞痛患者冠状动脉病变的相关性

Correlation of Left Atrial Volume Index and Coronary Artery Disease in Stable Angina Pectoris

目的探讨左心房容积指数(LAVI)与稳定型心绞痛患者冠状动脉病变程度的关系,为冠心病严重程度的判断提供线索。资料与方法选择稳定型心绞痛患者279例和正常对照组92例,根据冠状动脉造影结果分为单支病变组(116例)、2支病变组(93例)、3支病变组(70例),比较各组人口学特征、既往史、肝肾功能、超声心动图参数间的差异,并分析Gensini评分与LAVI的相关性;运用ROC曲线评估LAVI对3支病变的预测价值。结果 2支病变组和3支病变组的左心房内径(LAD)分别较对照组显著增大,3支病变组的LAD大于单支病变组(P<0.05);3支病变组的左心室舒张末期内径明显大于对照组、单支病变组的(P<0.05),3支病变组的E/Em值和LVMI明显高于其余各组(P<0.05);冠心病亚组的LAVI较对照组显著增加,3支病变组的LVMI高于单支病变组、2支病变组的(P<0.05);LAVI与Gensini评分呈正相关(r=0.499,P<0.01);LAVI对3支病变有一定的预测价值(AUC=0.782,P<0.01)。多因素Logistic回归分析结果显示,男性、高血压病、二尖瓣反流、冠状动脉病变支数多是LAVI升高的危险因素。结论冠状动脉病变程度越重,左心室舒张功能减退越明显。LAVI对3支病变有一定的预测价值。

PurposeTo investigate the relationship between left atrial volume index （LAVI） and severity of coronary lesions in patients with stable angina pectoris, so as to provide information for the evaluation of the severity of coronary artery disease （CAD）. Materials and MethodsAccording to the results of coronary angiography, 279 patients with stable angina pectoris and 92 healthy people were as control group, all subjects were divided into four groups： control group （n=92）, single-vessel CAD group （n=116）, double-vessel CAD group （n=93） and triple-vessel group （n=70）. Each group was compared in the aspects of demographic characteristics, history of illness, liver and kidney functions and parameter＇s difference in echocardiogram; the correlation between LAVI and Gensini score was analyzed; and the receiver operating characteristic （ROC） curve was used to identify the predictive value of LAVI in severity of coronary lesions.ResultsCompared with the control group, the double-vessel and triple-vessel CAD groups had significantly larger left atrial diameter （P〈0.05）. In triple-vessel CAD group, the left atrial diameter was significantly larger than that in the single-vessel CAD group （P〈0.05）, and the left ventricular end-diastolic diameter was significantly larger than that in the control group and in the single-vessel CAD group （P〈0.05）, and the E/Em and LVMI were significantly higher than those in other groups （P〈0.05）. The LAVI was higher in patients with CAD compared with those in the control group and the LAVI in the triple-vessel CAD group was significantly higher than that in single-vessel CAD group and double-vessel CAD group （P〈0.05）; the LAVI was correlated positively with Gensini score （r=0.499,P〈0.01）. LAVI had certain value in predicting triple-vessel CAD （AUC=0.782,P〈0.01）. The results of multi-factor Logistic regression analysis showed that male patients with hypertension, mitral reflux, and multi-vessel CAD were more likely to had high LAVI.Conclusion The worsening LV diastolic function is associated with the increasing severity of coronary artery lesions, and LAVI may have predictive value for severity of CAD.