实时三维超声联合二维斑点追踪成像评价原发性高血压患者左心房功能

Assessment of left atrial function using real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging in patients with essential hypertension

目的采用实时三维超声(RT-3DE)及二维斑点追踪成像(2D-STI)评估原发性高血压患者左心房形态和功能。方法收集70例原发性高血压患者,根据左心房内径指数将其分为左心房无扩大(NLAE)组(n=35)和左心房扩大(LAE)组(n=35),并收集35名健康志愿者为对照组。应用RT-3DE检测最大、最小和收缩前左心房容积(LAVmax、LAVmin、LAVpre),计算左心房每搏输出量(LASV)、总射血分数(LAEF)、主动射血分数(LAaEF)和被动排空分数(LApEF)。采用2D-STI计算左心房壁的收缩期、舒张早期和晚期平均峰值应变率(mSRs、mSRe、mSRa)。比较3组间上述参数的差异,分析2D-STI与RT-3DE测量参数的相关性。结果与对照组比较,NLAE组LAaEF、mSRa增高,LApEF、mSRs、mSRe降低(P均<0.05);与NLAE组比较,LAE组LAVmax、LAVpre、LAVmin、LASV、LAaEF、mSRa增高,LAEF、LApEF、mSRs、mSRe降低(P均<0.05)。NLAE组和LAE组中,mSRs与LAEF(r=0.70、0.77)、mSRe与LApEF(r=0.80、0.82)、mSRa与LAaEF(r=0.87、0.89)呈明显正相关(P均<0.01)。结论原发性高血压患者左心房在重构前即已发生功能改变;RT-3DE和2D-STI技术可用于评价原发性高血压患者左心房结构和功能。

Objective To evaluate the structure and function of left atrium(LA) in patients with essential hypertension by real-time three-dimensional echocardiography(RT-3 DE) and two-dimensional speckle tracking imaging(2 D-STI). Methods Totally 70 essential hypertension patients and 35 healthy volunteers(control group) were enrolled. The patients were divided into no left atrial enlargement(NLAE) group and left atrial enlargement(LAE) group(each n=35) according to left atrial index. Using RT-3 DE, the maximal, minimal and pre-systolic LA volume(LAVmax, LAVmin and LAVpre) were measured, the stroke volume, total ejection fraction, active ejection fraction and passive ejection fraction of LA(LASV, LAEF, LAaEF, LApEF) were calculated. Using 2 D-STI, the mean peak strain rates in systolic, early-diastolic, end-diastolic phase(mSRs, mSRe, mSRa) of LA were calculated. The parameters among the 3 groups were compared, the correlation between 2 D-STI and RT-3 DE measurement parameters were analyzed. Results Compared with control group, LAaEF and mSRa increased, while LApEF, mSRs and mSRe decreased in NLAE group(all P<0.05). Compared with NLAE group, LAVmax, LAVpre, LAVmin, LASV, LAaEF and mSRa increased, while LAEF, LApEF, mSRs and mSRe decreased in LAE group(all P<0.05). Significant positive correlations were found between mSRs and LAEF(r=0.70, 0.77), mSRe and LApEF(r=0.80, 0.82) as well as mSRa and LAaEF(r=0.87, 0.89) in NLAE and LAE group(all P<0.01). Conclusion LA function has changed before LA geometry changes in essential hypertension patients. RT-3 DE and 2 D-STI play important role in assessing LA function of essential hypertension patients.