实时三维超声自动左房定量技术评价左室射血分数保留的尿毒症血液透析患者左房功能

Assessment of left atrial function in uremic hemodialysis patients with preserved left ventricular ejection fraction by real-time three-dimensional ultrasound automatic left atrial quantification

目的应用实时三维超声自动左房定量(LAQ)技术评估左室射血分数(LVEF)保留的尿毒症血液透析患者左房功能。方法选取我院LVEF正常的尿毒症血液透析患者37例(尿毒症组)及同期健康体检者34例(正常对照组),两组均行常规超声检查和LAQ分析获取左室舒张末内径(LVEDd)、室间隔舒张末厚度(LVSd)、左室后壁舒张末厚度(LVPWd)、LVEF、二尖瓣口舒张早期和晚期血流速度峰值(E和A)、二尖瓣环舒张早期室间隔及左室侧壁组织运动速度(e’)、E/A、E与室间隔e’和左室侧壁e’均值的比值(E/e’)、肺毛细血管楔压(ePCWP)、肺动脉收缩压(PASP)、左房前后径(LAD1)、左房左右径(LAD2)、左房上下径(LAD3)、左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房射血分数(LAEF)、左房收缩前容积(LAVpreA)、左房最大容积指数(LAVImax)、左房射血容量(LAEV)、储存期纵向应变(LASr)、管道期纵向应变(LAScd)、收缩期纵向应变(LASct)、储存期周向应变(LASr-c)、管道期周向应变(LAScd-c)及收缩期周向应变(LASct-c),比较两组上述参数的差异;分析应变参数与LAEF、LAVImax的相关性。结果与正常对照组比较,尿毒症组LVEDd、IVSd、LVPWd、A、E/e’、ePCWP、PASP均增加,LVEF、E/A、室间隔e’和左室侧壁e’均降低,差异均有统计学意义(均P<0.05);两组E峰比较差异无统计学意义。与正常对照组比较,尿毒症组二维参数LAD1、LAD2、LAD3、LAVmax、LAVmin和三维参数LAVmin、LAVmax、LAVpreA、LAVImax、LAEV均增加,LAEF降低,差异均有统计学意义(均P<0.05);应变参数LASr、LAScd、LASct、LASr-c、LAScd-c均降低,差异均有统计学意义(均P<0.05);两组LASct-c比较差异无统计学意义。LAEF与LASr、LASr-c均呈正相关(均P<0.05),与LAScd、LASct、LAScd-c均呈负相关(均P<0.05),与LASct-c无相关性;LAVImax与LASr、LASr-c均呈负相关(均P<0.05),与LAScd、LAScd-c均呈正相关(均P<0.05),与LASct、LASct-c无相关性。结论尿毒症血液透析患者的心肌损害早于LVEF异常;实时三维超声LAQ所测左房容积和应变参数能全面、准确地评估其左房结构和功能的损害,为临床早期诊疗提供有价值的信息。

Objective ventricular ejection fraction(LVEF)by real-time three-dimensional ultrasound automatic left atrial quantification(LAQ).Methods enrolled in the study.Left ventricle end diastolic dimensions(LVEDd),interventricular septum diastolic thickness(IVSd),Left ventricle posterior wall diastolic thickness(LVPWd),LVEF,Peak E and A velocity,e’velocities on the septal and lateral mitral annulus,E/A,E/e’,pulmonary capillary wedge pressure(ePCWP),pulmonary artery systolic pressure(PASP),anteroposterior diameter(LAD1),medial-later diameter(LAD2),superior-inferior diameter(LAD3),left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin),left atrial ejection fraction(LAEF),left atrial volume at onset of contraction(LAVpreA),left atrial maximum volume index(LAVImax),left atrial ejection volume(LAEV),longitudinal strain(LASr)in reservoir phase and circumferential strain(LASr-c),longitudinal strain(LAScd)in conduit phase and circumferential strain(LAScd-c),longitudinal strain(LASct)in systolic phase and circumferential strain(LASct-c)were obtained by conventional ultrasonography and LAQ.The results of two groups were compared and analyzed,and the correlation between the strain parameters and LAEF and LAVImax were analyzed.ResultsCompared with the control group,the LVEDd,IVSd,LVPWd,A,E/e’,ePCWP,PASP in the case group were increased,while LVEF,E/A,e’on the septal and lateral mitral annulus were decreased,and the differences were statistically significant(all P<0.05).There was no significant difference in E between two groups.In the case group,two-dimensional parameters LAD1,LAD2,LAD3,LAVmax,LAVmin,and three-dimensional parameters LAVmin,LAVmax,LAVpreA,LAVImax,LAEV were significantly increased,while LAEF and strain parameters,including LASr,LAScd,LASct,LASr-c,LAScd-c were significantly decreased(all P<0.05).And LASct-c had no significant difference between two groups.LAEF had a positive correlation with LASr and LASr-c,and had a negative correlation with LAScd,LASct and LAScd-c(all P<0.05),but had no correlation with LASct-c.LAVImax had a negative correlation with LASr and LASr-c,and had a positive correlation with LASc and LAScd-c(all P<0.05),but had no correlation with LASct and LASct-c.Conclusion parameters measured by LAQ can be used to evaluate the left atrial structural and functional damage comprehensively and accurately,providing valuable information for early clinical diagnosis and treatment.