速度向量成像技术评估不同左室构型维持性血液透析患者左房功能

Assessment of left atrial function in maintenance hemodialysis patients with different left ventricular configurations by velocity vector imaging

目的应用速度向量成像(VVI)技术分析不同左室构型的维持性血液透析(MHD)患者左房功能。方法选取我院117例MHD患者,根据患者左室构型情况分为:正常构型组(24例)、向心性重构组(33例)、向心性肥厚组(36例)、离心性肥厚组(24例),另选同期年龄和性别与之相匹配的健康志愿者30例作为对照组,应用常规超声检测左房前后径(LAD)、左室舒张末期内径(LVEDd)、舒张末期室间隔厚度(IVSd)、左室后壁厚度(LVPWd)及二尖瓣舒张早期血流速度峰值与二尖瓣环舒张早期运动速度峰值比值(E/e);VVI技术于心尖四腔心切面获取左房整体收缩峰值应变(Ss)及应变率(SRs)、舒张早期峰值应变(Se)及应变率(SRe)、舒张晚期峰值应变(Sa)及应变率(SRa),比较各组上述各参数的差异;分析Ss、SRs、Se、SRe、Sa、SRa与E/e的相关性。结果向心性肥厚组和离心性肥厚组LAD、LVEDd、IVSd、LVPWd均较对照组及正常构型组增大,差异均有统计学意义(均P<0.05);对照组与正常构型组上述参数比较差异均无统计学意义。与对照组比较,MHD各组E/e、LVMI均增大,差异均有统计学意义(均P<0.05),且除正常构型组与向心性重构组比较差异无统计学意义外,余两两比较差异均有统计学意义(均P<0.05)。与对照组、正常构型组、向心性重构组、向心性肥厚组比较,离心性肥厚组LVEF减低,差异均有统计学意义(均P<0.05)。与对照组比较,MHD各组Ss、SRs、Se、SRe均减小,差异均有统计学意义(均P<0.05),正常构型组Sa、SRa均增大,向心性肥厚组和离心性肥厚组Sa、SRa均减小,差异均有统计学意义(均P<0.05);与正常构型组、向心性重构组比较,向心性肥厚组、离心性肥厚组Ss、SRs、Se、SRe、Sa、SRa均降低,差异均有统计学意义(均P<0.05);与向心性肥厚组比较,离心性肥厚组SRs、Se、Sa、SRa均降低,差异均有统计学意义(均P<0.05)。MHD患者Ss、SRs、Se、SRe、Sa、SRa与E/e均呈负相关(均P<0.01)。结论VVI技术可以简便、快捷、准确地评价MHD患者左房功能减退,为早期实施临床干预提供客观依据。

Objective To analyze the function of left atrium in maintenance hemodialysis(MHD)patients with different left ventricular configurations by velocity vector imaging(VVI).Methods Totally 117 patients with MHD were divided into the following groups according to their left ventricular configurations:normal configuration group(n=24),centripetal remodeling group(n=33),centripetal hypertrophy group(n=36),and centrifugal hypertrophy group(n=24).30 age-and sexmatched healthy volunteers were selected as the control group.Left atrial anteroposterior diameter(LAD),left ventricular end diastolic diameter(LVEDd),end diastolic ventricular septal thickness(IVSd),left ventricular posterior wall thickness(LVPWd)and the ratio of peak blood flow velocity in early diastole to peak motion velocity in early diastole(E/e)were measured by conventional ultrasound.Left atrial peak strain(Ss)and peak strain rate(SRs),early diastolic peak strain(Se)and peak strain rate(SRe),late diastolic peak strain(Sa)and peak strain rate(SRa)were obtained on apical four-chamber cardiac section images by the VVI technique.The changes of the above parameters in each group were compared,and the correlation of Ss,SRs,Se,SRe,Sa,SRa and E/e were analyzed respectively.Results LAD,LVEDd,IVSd and LVPWd in both centripetal hypertrophy group and centrifugal hypertrophy group were greater than those in control group and normal configuration group(all P<0.05).There were no significant difference in the above parameters between control group and normal configuration group.Compared with the control group,E/e and LVMI were increased in the normal configuration group,centripetal remodeling group,centripetal hypertrophy group and centrifugal hypertrophy group(all P<0.05),and pairwise comparison showed statistically significant differences except normal configuration group and centripetal remodeling group(all P<0.05).Compared with the control group,normal configuration group,centripetal remodeling group and centripetal hypertrophy group,LVEF was decreased in the centrifugal hypertrophy group(all P<0.05).Compared with the control group,Ss,SRs,Se and SRe were decreased in each MHD group(all P<0.05),Sa and SRa were increased in the normal configuration group(all P<0.05),and Sa and SRa were decreased in the centripetal hypertrophy group and the centrifugal hypertrophy groups(all P<0.05).Compared with the normal configuration group and the centripetal remodeling group,Ss,SRs,Se,SRe,Sa and SRa in the centripetal hypertrophy group and the centrifugal hypertrophy group were significantly decreased(all P<0.05).Compared with the centripetal hypertrophy group,SRs,Se,Sa,SRa in the centrifugal hypertrophy group were significantly decreased(all P<0.05).In MHD patients,Ss,SRs,Se,SRe,Sa,SRa were negatively correlated with E/e(all P<0.01).Conclusion VVI technique can easily,quickly and accurately evaluate left atrial hypoperfusion in patients with MHD,and provide an objective basis for early implementation of clinical intervention.