实时三维超声心动图评估左室射血分数正常的老年高血压患者左心房容积与功能

Assessment of left atrial volume and function by real-time three dimensional echocardiography in elderly hypertensive patients with normal left ventricular ejection fraction

目的应用实时三维超声心动图(RT-3DE)评估左室射血分数正常的老年高血压患者左心房容积与功能的变化。方法 79例老年原发性高血压患者,其中左室肥厚(LVH)组38例,非左室肥厚(NLVH)组41例,正常对照组28例。常规超声心动图测量左心房径(LAD)、二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A),计算E/A值。脉冲组织多普勒测定室间隔二尖瓣环处舒张早期峰值速度(E'),舒张晚期峰值速度(A'),计算E/E'。RT-3DE技术测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左房收缩前容积(LAVp),计算左房被动射血分数(LAPEF)、左房主动射血分数(LAAEF)。比较3组间各项检测指标的变化。结果与对照组比较,高血压NLVH组和LVH组的E/E'、LAVmax、LAVp、LAAEF均显著增加(P<0.05);高血压LVH组的LAD、LAVmin显著增加,差异有统计学意义(P<0.05),E/A及LAPEF均显著减低,差异有统计学意义(P<0.05)。结论实时三维超声技术可以评价高血压患者的左心房容积及功能,高血压患者左心房功能障碍在左室肥厚前即已发生,而LVH患者左心房功能及左室舒张功能障碍更为严重。

Objective To evaluate the change of left atrial volume and function in elderly hypertensive patients with normal left ventricular ejection fraction. Methods Seventy-nine elderly hypertensive patients were divided into LVH group（38 patients with left ventricular hypertrophy） and NLVH group（41 patients without left ventricular hypertro-phy） .Control group consisted of 28 normal subjects. Index of echocardiography,including left atrial diameter（ LAD） , mi-tral peak flow velocity during early and late diastole （E,A） ,ratio of E/A,peak velocities of interventricular septum sites at mitral annulus during early and late diastole （E^A^ ,and ratio of ,maximum left atrial volume（ LAVmax） ,min-imum left atrial volume（ LAVmin） , volume before contraction（ LAVp） of left atrial were acquired,left atrial passive and active ejection fraction （ LAPEF, LAAEF） were measured in all the subjects. Results Compared with normal group, E / ,LAVmax,LAVp,LAAEF of NLVH and LVH groups were significantly increased（P 〈0.05）. LAD and LAVmin of LVH group were significantly increased （P 〈0. 05）. E/A and LAPEF of LVH group were significantly decreased （P 〈 0. 05 ） . Conclusions RT-3DE provides a new method to evaluate left atrial volume and function. Left atrial function are impaired in NLVH group of elderly hypertension patients. The damage degree of left atrial function and LV diastolic function is more severe in LVH group.