二维斑点追踪超声心动图对二尖瓣反流患者左房功能的评估

The evaluation of left atrial function in patients with mitral regurgitation by two-dimensional speck-tracking echocardiography

目的采用二维斑点追踪超声心动图对不同程度二尖瓣反流患者的左房功能进行评估。方法选取85例来郑州大学第二附属医院就诊的二尖瓣反流患者,根据反流量的多少将患者分为三组:少量二尖瓣反流组(A组)、中等量组(B组)、大量组(C组),另设正常对照组(N组)。所有入选者先行常规经胸超声心动图检查,测量左房射血分数(LAEF),动态采集图像清晰的五个心动周期图像,通过二维斑点追踪软件进行脱机分析,获取相应的应变参数:左房整体纵向应变收缩期峰值(LAS-s)、左房整体纵向应变舒张早期峰值(LAS-e)、左房整体纵向应变舒张晚期峰值(LAS-a),同时获取相应的应变率参数:左房整体应变率收缩期均值(m SRs)、左房整体应变率舒张早期均值(mSRe)和左房整体应变率舒张晚期均值(mSRa),并分析应变、应变率参数与LAEF间的相关性。结果与N组比较,A组LAD(35.88±4.98)mm、LAEF(66.49%±4.89%)的变化无统计学差异(P均>0.05);B、C组LAD分别为(39.83±4.95)、(46.32±6.38)mm,逐渐增大,LAEF分别为(56.41%±6.02%)、(50.26%±4.56%),逐渐降低,差异均具有统计学意义(P均<0.05)。应变及应变率参数与N组相比,A组mSRa绝对值(3.26±0.23)升高;B、C组LAS-s绝对值分别为(31.25±3.57)、(27.38±3.69),LAS-e绝对值分别为(20.83±3.95)、(16.32±3.38),m SRs绝对值分别为(3.05±0.57)、(2.62±0.69),m SRe绝对值分别为(2.80±0.51)、(2.22±0.48),绝对值逐渐下降;LAS-a、m SRa绝对值在三组间呈先升后降趋势,即在B组升高,而在C组降低,差异均具有统计学意义(P均<0.05)。相关性分析结果显示,LAS-s、mSRs与LAEF值具有良好相关性(r分别为:0.071、0.064,P均<0.05)。结论二维斑点追踪超声心动图能快捷的获取左房应变及应变率参数,中、重度二尖瓣反流患者收缩期及舒张早期应变及应变率参数明显降低。

Objective To evaluate the left atrial function in patients with mitral regurgitation by two-dimensional speckle-tracking echocardiography(TDSTE).Methods Eighty-five patients with different degrees of mitral regurgitation who saw the doctor in the Second Affiliated Hospital of Zhengzhou University were selected and divided into three groups according to the amount of regurgitation:mild mitral regurgitation group(as group A),moderate mitral regurgitation group(as group B),and severe mitral regurgitation group(as group C);normal control group(group N)was set too.All the patients were first examined by conventional transthoracic echocardiography to measure their left atrial ejection fraction(LAEF),and five cardiac cycle images with clear images dynamically were collected.The off-line analysis was conducted by spot tracking software to generate the corresponding strain parameters as follows:the peak value of left atrial overall longitudinal strain systolic(LAS-s),the peak value of left atrial overall longitudinal strain early diastolic(LAS-e),and the peak value of left atrial overall longitudinal strain atrial diastolic(LAS-a).Meanwhile,the corresponding strain rate parameters were obtained:the systolic mean of the left atrial global strain rate(mSRs),the early diastolic mean of the left atrial global strain rate(mSRe)and the atrial diastolic mean of the left atrial global strain rate(mSRa).The correlation of strain and strain rate parameters with LAEF was also analyzed.Results Compared with group N,LAD(35.88±4.98 mm)and LAEF(66.49%±4.89%)values in group A showed no statistical significance(all P>0.05);LAD in group B and group C(39.83±4.95 mm,46.32±6.38 mm)gradually increased;LAEF in group B and group C(56.41%±6.02%,50.26%±4.56%)gradually decreased with statistically significant differences(all P<0.05).Regarding strain and strain rate parameters,compared with group N,the mSRa(3.26±0.23)value of patients in group A was increased.The absolute values in group B and group C were(31.25±3.57)and(27.38±3.69)for LAS-s,(20.83±3.95)and(16.32±3.38)for LASe,(3.05±0.57)and(2.62±0.69)for mSRs,and(2.80±0.51)and(2.22±0.48)for m SRe,respectively,which all decreased gradually.The absolute values of LAS-a and mSRa increased first and then decreased among groups A(18.07±3.87,3.26±0.23),B(26.25±4.32,3.75±0.32)and C(12.32±4.29,2.59±0.69).In other words,the absolute values of LAS-A and m SRa increased in group B,while they decreased in group C,and the differences were all statistically significant(all P<0.05).Correlation analysis results showed that LAS-S and mSRs had a good correlation with LAEF(r:0.071 and 0.064,respectively).Conclusion The left atrial strain and strain rate parameters can be quickly obtained by TDSTE;the systolic and early diastolic strain and strain rate parameters of patients with moderate and severe mitral regurgitation decreased significantly.