高血压患者应用二维斑点追踪技术早期评价左心房功能的研究

Left atrial early function in hypertensive patients:analysis from two-dimensional speckle tracking imaging

目的:探索应用二维斑点追踪技术(two-dimensional speckle tracking imaging,2D-STI)能否早期评价左房功能。方法:将高血压病人据病史分为单纯高血压(hypertension,HP)组和高血压伴阵发性房颤(paroxysmal atrial fibrillation,PAF)组(HP+PAF),根据左房容积指数(left atrial volume index,LAVI)分为左心房容积正常(left atrial normal,LAN)组和扩大组(left atrial enlargement,LAE),另选取健康人群为对照组。所有病例均行常规心脏超声检查,并采用Simpson法测量左房容积(left atrial volume,LAV),计算LAVI。运用2D-STI获取左房各壁于左室收缩期峰值应变率(strain rate systolic,SRs)、左室舒张早期峰值应变率(strain rate diastolic early,SRe)与左室舒张晚期峰值应变率(strain rate diastolic after,SRa),并计算左房整体平均峰值应变率(mSRs、mSRe、mSRa),多组间计量资料满足正态分布采用方差分析进行比较,不满足正态分布则采用多组间独立样本非参数检验进行比较,两组间采用非参数秩和检验(Kruskal-Wallis)检验。结果:HP组和HP+PAF组mSRs、mSRe绝对值小于对照组(P<0.01),而HP+PAF组的mSRs、mSRe绝对值小于HP组(P<0.01)。HP组和HP+PAF组mSRa绝对值较对照组增大(P<0.01),HP+PAF组mSRa绝对值较HP组减小(P<0.01)。LAN组和LAE组的mSRs、mSRe绝对值小于对照组(P<0.01),而LAE组的mSRs、mSRe绝对值小于LAN组(P<0.01),同时,LAN组和LAE组mSRa绝对值较对照组有明显增大(P<0.01)。结论:高血压患者左房功能较健康人群下降,合并房颤时下降更加明显。左房容积正常的高血压患者左房功能较健康人群已有下降,左房容积增大时左房功能进一步下降。提示2D-STI比左心房容积更敏感,能早期评价高血压患者左房功能改变,为临床及早干预提供了依据。

Objective：To explore whether the left atrial function could be assessed at early stage by using the two-dimensional speckle tracking imaging（2D-STI）.Methods：The hypertensive patients were divided into two groups based on the case histories：simple hypertension（HP）group and hypertension combining with paroxysmal atrial fibrillation（HP＋PAF）group.The patients were divided into two groups based on the left atrial volume index（LAVI）：normal left atrial volume（LAN）group and enlarged left atrial volume（LAE）group.Thirty healthy participants were served as the control group.The color doppler echocardiography was performed on all the participants.The left atrial volume（LAV）was measured by Simpson method,and the left atrial volume index（LAVI）was calculated.The systolic,early and late diastolic peak strain rate（SRs,SRe and SRa）curves were acquired in each left atrial segment by 2D-STI,and the average strain rates（mSRs,mSRe and mSRa）were calculated.Multiple sets of measurement data which meet the normal distribution were compared using analysis of variance.The non-parametric tests were performed using multiple sets of independent samples.The noncommutative rank sum test（Kruskal-Wallis）was used between the two groups.Results：The mSRs and mSRe absolute values were lower in HP and HP＋PAF groups than in control group（P〈0.01）.The mSRs and mSRe absolute values were lower in HP＋PAF group than in HP group（P〈0.01）.The mSRa absolute value was higher in HP and HP＋PAF groups than in control group（P〈0.01）.The mSRa absolute value was decreased in HP ＋PAF group compared with that of HP group（P〈0.01）.The mSRs and mSRe absolute values were lower in LAN and LAE groups than in control group（P〈0.01）.The mSRs and mSRe absolute values were lower in LAE group than in LAN group（P〈0.01）.The mSRa absolute value was increased in LAN and LAE groups than in control group（P〈0.01）.Conclusion：The left atrial function is de creased in hypertensive patients compared with that of healthy people,especially among those with hypertension combining with paroxysmal atrial fibrillation.The left atrial function is decreased in hypertensive patients with normal left atrial volume compared with that of healthy people.With the increase of the left atrial volume,the left atrial function is decreased further,indicating that the two-dimensional speckle tracking echocardiography is more sensitive than the left atrial volume for assessing the left atrial early function in hypertensive patients,and it could be helpful for the early intervention.