冠心病患者经皮冠状动脉介入术后左心房压力、功能变化及其与左心室功能的关系

Research on the changes of left atrial pressure and function and their relationship with left ventricular function in patients with coronary heart disease after percutaneous coronary intervention

目的应用组织多普勒成像(TDI)及二维斑点追踪显像(2D-STI)技术评价冠心病(CHD)患者经皮冠状动脉介入术(PCI)前后左心房压力和功能变化及其与左心室功能关系,为临床CHD的治疗提供更有效信息。方法对30例PCI术治疗的CHD患者分别在PCI术前、术后1周及术后3月经超声心动图测量并计算左心房最大容积(LAVmax)、最小容积(LAVmin)、左心房收缩前容积(LAVpre)、左心房被动排空分数(LAPEF)、左心房主动排空分数(LAAEF)、左心室射血分数(LVEF)、二尖瓣舒张早期速度峰值(E)及晚期速度峰值(A);采用TDI测量并计算二尖瓣环舒张早期速度(e’)、左心房平均压力(mLAP)、E/A及E/e’;采用2D-STI测量并计算左心室整体纵向应变(GLS),左心室收缩期、舒张早期及晚期左心房各壁平均峰值应变率(mSRs,mSRe,mSRa)。另选30例冠状动脉造影检查冠状动脉狭窄率<30%的病例作为对照组。结果CHD组与对照组比较,各时间段LVEF、LAPEF、E、E/A、e’、mSRs、mSRe、GLS均下降,A、E/e’、mLAP、LAVmin、LAVmax、LAVpre、LAAEF、mSRa均升高(P<0.05)。CHD组PCI术后1周与术前比较,各项指标差异均无统计学意义(P>0.05);CHD组PCI术后3月与术前、术后1周比较,E、e’、E/A、mSRs、mSRe、GLS、LVEF、LAPEF均上升,A、E/e’、mLAP、LAVmin、LAVmax、LAVpre、LAAEF、mSRa均下降(P<0.05)。CHD组PCI术后3月mLAP与GLS、mSRe、LAVmin、LAVmax、LAVpre呈正相关(r=0.548,0.871,0.851,0.858,0.857,P<0.01),与LVEF、E/A、mSRa、mSRs、LAPEF呈负相关(r=-0.800,-0.884,-0.898,-0.829,-0.427,P<0.05)。结论CHD患者左心房及左心室功能在PCI术后3月较术后1周、术前明显改善;左心房压力与功能变化可以综合反映CHD患者PCI术后左心房及左心室功能改变,二者功能紧密联系。

Aim Tissue Doppler imaging(TDI)and two-dimensional speckle tracking imaging(2 D-STI)were used to evaluate the changes of left atrial pressure and function and their relationship with left ventricular function in patients with coronary heart disease(CHD)before and after percutaneous coronary intervention(PCI),so as to provide more effective information for clinical treatment of CHD.Methods Maximal left atrial volume(LAVmax),minimal left atrial volume(LAVmin),pre-atrial contraction left atrial volume(LAVpre),left atrial passive emptying fraction(LAPEF),left atrial active emptying fraction(LAAEF),left ventricular ejection fraction(LVEF),early velocity of mitral valve(E),atrial contractile velocity of mitral valve(A)were measured and calculated by echocardiography before PCI,1 week after PCI and 3 months after PCI in 30 CHD patients.Early diastole velocity of mitral valve annulus(e’),left atrial mean pressure(mLAP),E/A and E/e’were measured and calculated by TDI.Left ventricular systolic global longitudinal strain(GLS),mean systolic peak strain rate(mSRs),mean early diastolic peak strain rate(mSRe),mean late diastolic peak strain rate(mSRa)were measured and calculated by 2 D-STI.Another 30 cases with coronary artery stenosis rate less than 30%measured by coronary angiography were selected as the control group.Results Compared with the control group,LVEF,LAPEF,E,E/A,e’,mS Rs,mS Re and GLS decreased,A,E/e’,mL AP,LAVmin,LAVmax,LAVpre,LAAEF and mS Ra increased at different time in the CHD group(P<0.05).In the CHD group,there were no significant difference in all the indexes between 1 week after PCI and before PCI(P>0.05);Compared with before PCI and 1 week after PCI,E,e’,E/A,mS Rs,mS Re,GLS,LVEF and LAPEF increased,while A,E/e’,mL AP,LAVmin,LAVmax,LAVpre,LAAEF and mS Ra decreased at 3 months after PCI(P<0.05).At 3 months after PCI in the CHD group,mL AP was positively correlated with GLS,mS Re,LAVmin,LAVmax and LAVpre(r=0.548,0.871,0.851,0.858,0.857,P<0.01),and negatively correlated with LVEF,E/A,mS Ra,mS Rs and LAPEF(r=-0.800,-0.884,-0.898,-0.829,-0.427,P<0.05).Conclusions The function of left atrium and left ventricle in CHD patients is improved significantly in 3 months after PCI compared with that in 1 week after PCI and before PCI.The changes of left atrial pressure and function can comprehensively reflect the changes of left atrial and left ventricular function in CHD patients after PCI,which are closely related to each other.