应变/应变率成像评价慢性心力衰竭患者左心房功能

Evaluation of left atrial function in patients with chronic congestive heart failure using strain/strain rate imaging

目的应用组织多普勒应变/应变率成像技术评价慢性心力衰竭(CHF)患者左心房功能的变化。方法共纳入48例CHF患者和41例健康人(对照组)。行常规超声心动图检查,应用应变/应变率成像技术测量左房5个壁心肌组织的应变(S)、应变达峰时间(TS),左室收缩期左房应变率峰值(SSR)、左室舒张早期左房应变率峰值(ESR)、左室舒张晚期左房应变率峰值(ASR),对两组指标进行比较。结果与对照组相比较,CHF组左房内径(LAD)、左房内径指数(LADI)、左房最小容积(LAVmin)、左房最大容积(LAVmax)、左房容积指数(LAVI)、左房每搏量(LASV)均明显高于对照组(均为P<0.05),左房射血分数(LAEF)低于对照组(P=0.02)。CHF组除左心房前壁外,左心房其余各壁应变均显著降低。CHF组SSR减低,ESR及ASR均明显减低(均为P<0.05)。结论慢性心力衰竭患者左心房功能较健康人减低,应用应变/应变率成像技术能够定量评价慢性心力衰竭患者左心房功能的变化。

Objective To evaluate the changes of left atrial （LA） structure and function in patients with chronic heart failure （CHF） using Strain/Strain Rate Imaging echocardiography （SRI）. Methods Conventional echocardiography and tissue Doppler imaging were performed in 48 CHF patients and 41 healthy control subjects. Strain （S）, time to peak strain （TS）, peak systolic strain rate （SSR）, peak early diastolic strain rate （ESR） and peak late diastolic strain rate （ASR） values were compared between the 2 groups and used to evaluate their LA function. Results Compared with the control group, left atrial diameter （ LAD）, left atrial diameter index （ LADI ）, left atrial minimal volume （ LAVmin）, left atrial maximal volume （LAVmax）, left atrial volume index （LAVI） and left atrial stroke volume （LASV） significantly increased in the CHF group （ all P 〈 0. 05 ）, while left atrial ejection fraction （LAEF） in the CHF group decreased significantly（ P =0. 02）. Strain of Left atrial lateral wall（ SLALW）, strain of left atrial septum（ SIAS）, strain of left atrial inferior wall （SLAIW） and strain of left atrial posterior wall （SLAPW） were all decreased significantly in CHF patients but strain of left atrial anterior wall （SEAAW） when compared with the control group. In patients with CHF, SSR, ESR and ASR were significantly lower than those in controls（ all P 〈 O. 05 ）. Conclusions Left atrial reservoir function, booster pump function and conduit function decrease in CHF patients compared to those in normal individuals. SRI can quantitatively evaluate left atrial function in patients with CHF.