二维斑点追踪技术和实时三维超声心动图评价冠状动脉旁路移植术后左心房功能变化

Evaluation on changes of left atrial function after coronary artery bypass grafting using two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography

目的应用二维斑点追踪技术(2D-STI)和实时三维超声心动图(RT-3DE)评价冠状动脉旁路移植术(CABG)后左心房功能变化。方法收集因多支冠状动脉病变接受CABG治疗的30例患者(CABG组)和30名健康志愿者(对照组),采用2D-STI测量对照组及CABG组术前及术后1个月、术后3个月左心房应变曲线,获得左心房储备应变(εs)、管道应变(εe)和收缩应变(εa);采用RT-3DE测量患者左心房最大容积(LAV_(max))、最小容积(LAV_(min))和收缩前容积(LAV_p),计算左心房被动射血分数(LAPEF)和主动射血分数(LAAEF)。对CABG左心房应变率、容积变化率与术后3个月及术前舒张早期E峰/二尖瓣瓣环舒张早期e'峰差值(ΔE/e')进行相关性分析。结果 CABG组术前、术后1个月、术后3个月与对照组εa、LAAEF总体差异无统计学意义(P均>0.05);εs、εe、LAV_(max)、LAV_(min、)LAV_p、LAPEF总体差异均有统计学意义(P均<0.05),CABG组术前εs、εe、LAPEF较对照组下降,LAV_(max)、LAV_(min)、LAV_p较对照组增高,术后1个月、3个月εs、εe、LAPEF较术前增高,LAV_(max)、LAV_(min)、LAV_p较术前降低(P均<0.05),术后3个月与1个月εs、εe、LAV_(max)、LAV_(min)、LAV_p、LAPEF差异均有统计学意义(P均<0.05)。CABG组术后3个月LAV_(max)、LAV_(min)和LAV_p变化率与ΔE/e'呈正相关(r=0.608、0.631、0.587,P均<0.01),左心房εs、εe变化率与ΔE/e'均呈负相关(r=-0.615、-0.637,P均<0.01)。结论 2D-STI和RT-3DE可动态评价CABG前后左心房功能变化,对评估CABG术后患者心肌功能改善情况及预后具有一定价值。

Objective To evaluate changes of left atrial function after coronary artery bypass grafting (CABG) with two-dimensional speckle tracking imaging (2D-STI) and real-time three-dimensional echocardiography (RT-3DE). Methods Totally 30 patients with multivessel coronary artery disease treated with CABG (CABG group) and 30 healthy volunteers (control group) were enrolled.2D-STI was used to measure the left atrial strain curve,i.e.left atrial reserve strain (εs),conduit strain (εe) and contraction strain (εa) in control group and CABG group before operation,as well as 1 month and 3 months after operation.RT-3DE was used to measure maximum left atrium volume (LAV max),minimum left atrial volume (LAV min),pre-systolic left atrial volume (LAV P),left atrial passive ejection fraction (LAPEF) and active ejection fraction (LAAEF).Correlation analysis was performed between the ratio of left atrial strain,volume change and difference value of peak mitral flow velocity (E)/mitral annular peak velocity (e') 3 months after CABG and pre-operation (ΔE/e'). Results εa and LAAEF showed no significant difference among CABG group before operation,1 month,3 months after operation and the control group (both P >0.05),whereas εs,εe,LAV max,LAV min, LAV p and LAPEF were statistically significant (all P <0.05).Compared with control group,before CABG,εs,εe and LAPEF decreased,LAV max,LAV min and LAV p increased (all P< 0.05),while compared with those before operation,εs,εe and LAPEF increased,LAV max,LAV min and LAV p decreased 1 month and 3 months after operation (all P <0.05),the differences of εs,εe,LAV max,LAV min,LAV p and LAPEF were statistically significant between 3 months and 1 month after operation (all P <0.05).The rate of changes of LAV max,LAV min, LAV p in CABG group 3 months after operation was positively correlated with ΔE/e'( r =0.608,0.631,0.587,all P <0.01),while of left atrium εs,εe was negatively correlated with ΔE/e'( r =-0.615,-0.637,all P <0.01). Conclusion 2D-STI and RT-3DE can dynamically evaluate the left atrium function before and after CABG,and have certain value in evaluating the improvement of myocardial function and prognosis after CABG.