实时三维超声心动图联合二维斑点追踪评估原发性高血压病患者左房功能

Evaluation of left atrial function in patients with essential hypertension by real-time three-dimensional echocardiography combined with two-dimensional speckle tracking

目的探讨实时三维超声心动图(RT-3DE)联合二维斑点追踪(2D-STI)在原发性高血压病(EH)患者左房功能评估中的应用价值。方法86例EH患者根据左房内径指数分为左房无扩大组43例和左房扩大组43例,另选同期体检的70例健康成人为正常对照组;使用RT-3DE检测各组左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房每搏量(LASV)、整体射血分数(LAEF)、左房主动射血分数(LAAEF)、左房被动射血分数(LAPEF)及左房收缩前容积(LAVpre);使用2D-STI检测各组左房不同壁峰值应变率及左房舒张早期与晚期峰值应变率的平均值(mSRs、mSRe、mSRa);分析左房容积与左房应变率之间的相关性。结果左房扩大组各RT-3DE检查参数与左房无扩大组和正常对照组比较差异均有统计学意义(均P<0.05),且左房无扩大组LAAEF、LAPEF及LAVpre与正常对照组比较差异均有统计学意义(均P<0.05)。左房扩大组各2D-STI检查参数与左房无扩大组和正常对照组比较差异均有统计学意义(均P<0.05),且左房无扩大组与正常对照组比较差异均有统计学意义(均P<0.05)。相关性分析显示EH患者mSRs与LAEF、mSRe与LAPEF、mSRa与LAAEF均呈正相关(r=0.694、0.807、0.837,P=0.000、0.002、0.000)。结论RT-3DE联合2D-STI不仅可以准确检出EH患者左房重构,还可以评估其心肌功能,早期发现EH患者心房心肌功能受损,具有较好的临床应用价值。

Objective To investigate the application value of real-time three-dimensional echocardiography(RT-3DE)combined with two-dimensional speckle tracking imaging(2D-STI)in the evaluation of left atrial function in patients with essential hypertension(EH).Methods According to the index of the left atrium diameter,86 patients with EH were divided into the non-left atrial enlargement(NLAE)group of 43 cases and the left atrial enlargement(LAE)group of 43 cases.70 healthy subjects who were examined in the same period as the control group.The changes of the left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin),left atrial stroke volume(LASV),global ejection fraction(LAEF),active ejection fraction(LAAEF),passive ejection fraction(LAPEF)and left atrial pre systolic volume(LAVpre)were measured by RT-3DE.The peak strain rate of different left atrial walls,the mean value of early and late diastolic peak strain rate(mSRs,mSRe,mSRa)were measured by 2D-STI.The correlation between the parameters of left atrial volume and left atrial strain rate was analyzed.Results The RT-3DE parameters of the LAE group were significantly different from those of the NLAE group and the normal control group(all P<0.05),and the differences of LAAEF,LAPEF and LAVpre between NLAE group and the normal control group were statistically significant(all P<0.05).The 2D-STI parameters of the LAE group were statistically different from those of the NLAE group and the normal control group(all P<0.05).The differences between the NLAE group and the normal control group were statistically significant(all P<0.05).Correlation analysis showed that mSRs and LAEF,mSRe and LAPEF,mSRa and LAAEF in EH patients were positively correlated(r=0.694,0.807,0.837,P=0.000,0.002,0.000).Conclusion RT-3DE combined with 2D-STI can not only accurately detect the left atrial remodeling in EH patients,but also assess the myocardial function.It has good clinical application value in early detection of impaired atrial myocardial function in patients with EH.