双多普勒同步取样技术评价正常成年人不同年龄组心房内及心房间同步性

Evaluating the changes of intra- and interatrial synchronization with age in normal adults by dual gate Doppler

目的采用双多普勒同步取样技术（双多普勒技术）分析正常成年人心房内及心房间同步性的增龄变化特点，并进一步探讨双多普勒技术评价心房同步性的可行性。方法选取到我院健康体检的成年志愿者57例，按年龄分布分为A组（20～39岁，20例）、B组（40～59岁，21例）、C组（60～79岁，16例）。采用双多普勒技术将两个取样容积分别置于二尖瓣环室间隔（s）及侧壁（L）位点、三尖瓣环s及右室游离壁（RVFW）位点、二尖瓣环L及三尖瓣环RVFw位点，同步获取两个位点心肌组织运动频谱a’波起始点的时间差分别为T1、T2、T3。采用传统多普勒技术分别获得从心电图P波起始点到二尖瓣环I．、s及三尖瓣环RVFw二三个位点心肌组织运动频谱a’波起始点的时间差分别为PI．、P—S、P—RVFW。P—L与P—S、PS与PRVFW、P—L与P—RVFw之间的时间差分别为t1、t2、t3、T1、t1用以评估左房同步性，T2、t2用以评估右房同步性，T3、t3用以评估双房同步性，其值越大，表明心房同步性越差。结果①A组、B组、c组收缩压、舒张压依次增高（P〈0．05）；与A组比较，B组及c组舒张早期二尖瓣口血流峰值速度（E）与瓣环室间隔位点速度（e‘）比值（E／e‘）、舒张晚期二尖瓣口血流峰值速度增大；与A组及B组比较，c组左房容积（LAV）增大，E减低（均P〈0．05），余指标差异均无统计学意义（P〉0．05）。②与A组比较，B组及C组T1、T2、T3及t1、t2、t3均增大（P〈0．05）。③T1、T2、T3与年龄、体质指数、收缩压、左房前后径、E／e’均呈正相关（P〈0．05），T1与LAV呈正相关（P〈0．05），T3与LAV、右房上下径呈正相关（均P〈0．05），与其余指标无显著相关性。④双多普勒技术与传统多普勒技术测量心房同步性参数的一致性较好，两种方法测值的相关系数为0．78（P〈0．01）。对于同一观察者及不同观察者，双多普勒技术测量同步性参数的组内相关系数（ICC）均高于传统多普勒技术，其测值95％可信区间范围小于传统多普勒技术。结论正常成年人心房内及心房间同步性随年龄增加逐渐减低，双多普勒技术测量的心房同步性参数较传统多普勒技术重复性更好，有望为临床提供一种准确评价心房同步性的新方法。

Objective normal adults by dual gate synchronization. Methods To evaluate the changes of intra and interatrial synchronization with age in Doppler and discuss the feasibility of dual gate Doppler in assessing atrial Fifty-seven healthy volunteers were divided into three groups according to age： group A （20- 39 years old, n = 20）, group B （40- 59 years old, n = 21 ）, group C （6（I- 79 years old, n = 16）. The time interval of the onset of a＇ wave between mitral annular septal and lateral site was T1 by dual gate Doppler, which was used to evaluate left atrial synchronization. The time intervals from the onset of a＇ wave at tricuspid annular right ventricular free wall site to ar wave at tricuspid annular septal site and mitral annular lateral site were T2 and T3, which were respectively used to evaluate right atrial and interatrial synchronization. With traditional Doppler technique, the time intervals from the onset of P wave to the onset of aI wave at the mitral annular lateral site （P L）, the mitral annular septal site （P S）, and the tricuspid annular right ventricular free wall site （P RVFW） were measured. The time differences between P-L and P- S, between P S and P RVFW,and between P-L and P RVFW were tl （left atrial synchronization）, t2 （right atrial synchronization）, t3 （interatrial synchronization）. The greater time interval predicted the worse synchronization. Results ① Systolic and diastolic blood pressure elevated with age among three groups （P〈0.05）. Compared with group A, the ratio （E/e＇） of early diastolic transmitral flow velocity （E） and mitral annular velocity of septal site （er） , and late diastolic transmitral flow velocity increased in group B and C. In contrast with group A and B, left atrial volume （LAV） increased, and E decreased in group C （all P 〈0. 05）. ②Compared with group A, T1, T2, T3 and tl, t2, t3 increased in group B and C （all P 〈0.05）. ③T1, T2 and T3 were positively correlated with age, body mass index, systolic blood pressure, left atrial systolic antero posterior diameter and E/er （all P 〈0. 05）. Besides, T1 was positively correlated with LAV （P 〈0.05）. T3 was positively correlated with LAV and right atrial upper-inferior diameter. ④ The parameters of atrial synchronization in dual gate Doppler were concordant with that in traditional Doppler technique. And the measurements of two methods were correlated （ r = 0.78, P 〈0.01）. For inter- and intraobservers, the interclass correlation coefficient with dual gate Doppler was higher and 95 % confidence interval range was smaller. Conclusions The intra- and interatrial synchronization reduces with age in normal adults. Dual gate Doppler is feasible in evaluating atrial synchronization, which can provide more repeatable measurements and can be a new prospective method to assess atrial synchronization.