实时三维斑点追踪成像评价冠心病合并二尖瓣反流患者左心房功能

Assessment of Left Atrial Function by Real-time Three-dimensional Speckle Tracking Imaging in Coronary Heart Disease with Mitral Regurgitation

目的应用实时三维斑点追踪成像(RT3D-STI)技术检测冠心病合并二尖瓣反流患者的左心房容积变化及心肌应变,评价左心房功能。资料与方法采集88例冠心病患者,根据有无二尖瓣反流(MR)分为无MR组(30例)及MR组(58例,包括轻度反流20例、中度反流20例、重度反流18例)。对照组为30例健康志愿者。应用RT3D-STI分别测量左心房最大容积(LAVmax)、左心房主动收缩前容积(LAVp)、左心房最小容积(LAVmin)及左心房心肌整体纵向、径向、圆周应变(GLS、GRS、GCS),计算左心房被动及主动射血分数(LApEF、LAaEF),并分析左心房心肌应变与左心室功能的关系。结果 (1)无MR组与MR组左心房射血分数(LAEF)、左心室射血分数(LVEF)、LApEF均较对照组降低(P<0.05),且MR组LApEF低于无MR组(P<0.05);(2)无MR组与MR组心肌GLS及GCS均低于对照组(P<0.05),且MR组低于无MR组(P<0.05);随反流程度的增加,GLS、GCS及GRS均不同程度降低;(3)左心房心肌整体应变能力(GLS、GCS、GRS)与LAEF呈显著相关(无MR组:r=-0.810、-0.760、0.851;MR组:r=-0.680、-0.745、0.583;P<0.05)。结论 RT3D-STI技术可通过测量左心房容积变化、计算LAEF及追踪心肌运动,评价MR患者左心房心肌运动的改变及评估左心房功能,为临床诊断及治疗提供参考依据。

Purpose To detect left atrial volume change and myocardial strain, and to evaluate left atrial（LA） function in coronary heart disease patients with mitral regurgitation（MR） by real-time three-dimensional speckle tracking imaging（RT3D-STI）. Materials and Methods Eighty-eight patients with coronary disease were divided into non mitral regurgitation group（NMR group, n=30） and mitral regurgitation group（MR group, n=58）, including mild MR（n=20）, moderate MR（n=20） and severe MR（n=18）. Thirty healthy participants were also included as control group. Using RT3D-STI, the global atrial longitudinal strain（GLS）, global radial strain（GRS）, global circumferential strain（GCS）, LA maximal, minimal and pre-systolic volume（LAVmax, LAVmin and LAVp）, LA passive ejection fraction（LApEF） and LA active ejection fraction（LAaEF） were measured, and the relationship between LA myocardial strain and left ventricular function was analyzed. Results（1） The LAEF, LVEF, LApEF in NMR group and MR group decreased compared those with the control group（P〈0.05）, and the LApEF in MR group were lower than those in NMR group（P〈0.05）;（2） compared with the control group, the GLS and GCS in NMR group and MR group decreased observably（P〈0.05）, and the parameters in MR group was lower than those in NMR group（P〈0.05）; along with the severity of mitral regurgitation, GLS, GCS and GRS declined in varying degrees.（3） The overall strain ability of left atrial myocardium（GLS, GCS, GRS） had a positive correlation with LAEF（NMR group： r=-0.810,-0.760 and 0.851; MR group： r=-0.680,-0.745 and 0.583; P〈0.05）. Conclusion RT3D-STI plays an important role in assessing LA myocardial movement change and evaluating left atrial function of mitral regurgitation patients by nvestigating left atrial volume change, calculating LAEF and tracing myocardial motion, which provides valuable references for clinical diagnosis and treatment.