三维斑点追踪成像技术对高血压患者左心房功能的评价

Evaluation of left atrial function in hypertensive patients by three-dimensional speckle tracking imaging

目的应用三维斑点追踪成像技术评价不同时相左心房容积、射血分数和应变功能参数在左心室重构和非重构高血压患者中的变化特征。方法收集2020年1月至2020年8月在四川省人民医院进行心脏超声检查的高血压患者90例(左心室重构组40例,非重构组50例),另选取健康受试者40例,均进行标准三维和二维经胸超声心动图图像采集及参数分析。测量比较3组受试者的常规心脏参数,左心房储器、管道及泵时相的长轴和圆周应变,不同时相左心房射血分数,左心室整体长轴应变等,并研究不同时相左心房应变与射血分数、左心室整体长轴应变的相关性。结果与健康受试者相比,高血压非左心室重构组左心房管道及泵时相的长轴应变降低(11.7%±3.0%vs 14.6%±1.4%、12.6%±3.4%vs 15.2%±2.2%),而储器、管道及泵时相圆周应变增加(34.3%±6.3%vs 29.0%±5.1%、14.6%±3.1%vs 12.4%±2.1%和19.3%±4.4%vs 16.6%±2.3%,均P<0.05);左心室重构高血压组的左心房不同时相容积均显著增加(均P<0.05),射血分数、长轴及圆周应变均显著降低(均P<0.05)。左心室重构高血压患者不同时相的左心房长轴及圆周应变与射血分数、左心室整体长轴应变均呈正相关(r=0.35~0.77,均P<0.05),左心房管道圆周应变与储器、泵功能射血分数及左心室整体长轴应变相关性最高,相关系数r分别为0.77、0.71、0.66。结论复杂的左心房功能可以应用三维斑点追踪成像技术来评价,包括快速获取不同时相左心房射血分数、左心房长轴及圆周应变参数,圆周应变是反映左心房功能的重要参数。三维斑点追踪成像可为早期发现高血压患者左心房功能改变及临床早期干预提供有价值的信息。

Objective To evaluate the characteristics of left atrial(LA)volume,ejection fraction,and strain parameters at different phases in hypertensive patients with or without left ventricular remodeling by three-dimensional speckle tracking echocardiography.Methods A total of 90 hypertension patients(40 in left ventricular remodeling group and 50 in non-remodeling group)and 40 healthy subjects who underwent cardiac ultrasound examination at Sichuan Provincial People's Hospital from January 2020 to August 2020 were collected.Standard three-dimensional and two-dimensional transthoracic echocardiography images were collected and parameters were analyzed.Conventional cardiac parameters,LA longitudinal and circumferential strain, LA ejection fraction, and the global longitudinal strain (GLS) ofthe left ventricle were compared among the three groups, and the correlations between these parameterswere analyzed. Results Compared with healthy subjects, longitudinal strain of LA conduit and contractionphases decreased significantly in the non-remodeling hypertension group (11.7%±3.0% vs 14.6%±1.4%,12.6%±3.4% vs 15.2%±2.2%, P<0.05), while the circumferential strain of reserve, conduit, andcontraction phases increased significantly (34.3%±6.3% vs 29.0%±5.1%, 14.6%±3.1% vs 12.4%±2.1%,and 19.3%±4.4% vs 16.6%±2.3%, respectively;P<0.05 for all). The volumes at different phases weresignificantly increased in the remodeling hypertensive group, while LA ejection fraction and longitudinal andcircumferential strain were significantly decreased (P<0.05 for all). For hypertensive patients, the LAlongitudinal and circumferential strain were significantly correlated with LA ejection fraction of differentphases and GLS (r=0.35-0.77, P<0.05 for all). Conclusion The complex LA function can be evaluated bythree-dimensional speckle tracking echocardiography, including the quick acquisition of LA ejection fractionand longitudinal and circumferential strain at different phases. Circumferential strain is one of the mostimportant LA parameters . Three-dimensional speckle tracking imaging can provide valuable information forearly detection of left atrial function changes and early clinical intervention in patients with hypertension.