二维斑点追踪技术测量高血压病患者房间隔厚度及其与左房功能的关系

Relationship between atrial septal thickness and left atrial function in patients with essential hypertension by two-dimensional speckle tracking imaging

目的应用二维斑点追踪(2D-STI)技术评价原发性高血压病患者房间隔厚度与左房功能的关系。方法选取原发性高血压病患者41例,根据左房容积指数分为左房重构组20例和左房非重构组21例,另选健康体检者25例为正常对照组,应用2D-STI技术测得各组左房收缩期、舒张早期、舒张晚期的左房平均应变率(mSRs、mSRe、mSRa);应用实时三维容积成像技术(RT-3DE)结合心电图时相获取左房最大容积(LAVmax)、左房收缩前容积(LAVpre)、左房最小容积(LAVmin),并计算左房被动排空指数(LAEFp)、左房主动排空指数(LAEFa)及左房总排空分数(LAEF);M型超声测量收缩期房间隔厚度(IASTs)及舒张期房间隔厚度(IASTd),计算房间隔增厚率(ASTDF)。比较各组上述参数的差异,分析ASTDE与左房各功能参数间的相关性。结果与正常对照组比较,左房非重构组和左房重构组mSRs、mSRe、LAEFp、LAEF均减低,mSRa、LAEFa及ASTDF均增高,差异均有统计学意义(均P<0.05);与左房非重构组比较,左房重构组的mSRs、mSRe、LAEFp、LAEF均减低,mSRa、LAEFa、IASTs、IASTd、ASTDF均增高,差异均有统计学意义(均P<0.05)。相关性分析显示,ASTDF与LAEFa、mSRa、LAEF均呈正相关(r=0.568、0.249、0.266,均P<0.05)。结论2D-STI能够发现原发性高血压病患者早期左房结构和功能的改变,房间隔厚度和ASTDF可作为左房功能早期改变的补充预测指标。

Objective To evaluate the relationship between atrial septal thickness and left atrial function in patients with essential hypertension by two-dimensional speckle tracking imaging(2D-STI).Methods Forty-one patients with hypertension were involved.According to the left atrial volume index,they were divided into left atrial remodeling group(LAR group,n=20)and without left atrial remodeling group(LAN group,n=21),and 25 healthy subjects were enrolled as control group.The mean strains rates(mSRs,mSRe,mSRa)of left atrial wall and atrial septum were measured by 2D-STI technique.The left atrial maximum volume(LAVmax),left atrial pre-systolic volume(LAVpre),left atrial minimum volume(LAVmin)were obtained by real-time three-dimensional echocardiography(RT-3DE)combined with ECG phase.Meanwhile,the left atrial passive emptying index(LAEFp),left atrial active emptying index(LAEFa)and left atrial dilation index(LAEF)were calculated.Atrial septal thickness in systolic period(IASTs)and atrial septal thickness in diastolic period(IASTd)were measured by Mmode ultrasound,and the atrial septal thickening rate(ASTDF)was calculated.The differences of the above parameters in each group was compared,and the correlation between the atrial septal thickening rate and the left atrial function parameters was analyzed.Results Compared with the control group,the mSRs,mSRe,LAEFp and LAEF were significantly decreased in the LAN group,while the mSRa,LAEFa and ASTDF were increased(all P<0.05).Compared with the LAR group,mSRs,mSRe,LAEFp and LAEF were significantly decreased in the LAR group,while the mSRa,LAEFa,IASTs,IASTd and ASTDF were increased(all P<0.05).There was positive correlation between ASTDF and LAEFa,mSRa,LAEF,respectively(r=0.568,0.249,0.266,all P<0.05).Conclusion 2D-STI technique can detect the changes of left atrial structure and function in patients with essential hypertension at early stage.Atrial septal thickness and ASTDF can be used as supplementary predictors of early changes in left atrial function.