四维自动左房定量技术评价肥厚型心肌病患者左心房功能的价值

Evaluation of Left Atrial Function in Patients with Hypertrophic Cardiomyopathy by Four-Dimensional Automatic Left Atrial Quantitative Technology

目的探讨四维自动左房定量(4D Auto LAQ)技术评估肥厚型心肌病(HCM)患者左心房功能改变的应用价值。方法选取2021年3—12月于郑州大学第一附属医院就诊的40例HCM患者(梗阻性20例,非梗阻性20例)及健康者20例(对照组)。应用4D Auto LAQ软件分析获得左房最大容积(LAV_(max))、左房最小容积(LAV_(min))、左房收缩前容积(LAVpre)、左房容积指数(LAVI)、左房储备期纵向应变(LASr)、左房储备期圆周应变(LASr-c)、左房通道期纵向应变(LAScd)、左房通道期圆周应变(LAScd-c)、左房收缩期纵向应变(LASct)、左房收缩期圆周应变(LASct-c)、左室整体纵向应变(LVGLS)、左室整体周向应变(LVGCS),计算左房总排空分数(LAtEF)、左房被动排空分数(LApEF)、左房主动排空分数(LAaEF)。比较各组参数的差异。采用Spearman相关性分析左心房功能变化与左心室功能的相关性。绘制受试者工作特征(ROC)曲线比较各4D Auto LAQ参数对诊断HCM患者左房功能障碍的准确性。进行观察者内、观察者间4D Auto LAQ参数的重复性检验。结果与对照组比较,梗阻性HCM组和非梗阻性HCM组LAV_(max)、LAV_(min)、LAVpre、LAVI均增大,LASr、LASr-c、LAScd-c、LASct、LAtEF、LApEF及LVGLS均降低(P<0.05);与非梗阻性HCM组比较,梗阻性HCM组LAV_(max)、LAV_(min)、LAVpre、LAVI增大,LAScd降低(P<0.05)。Spearman相关分析结果显示梗阻性HCM组、非梗阻性HCM组LASr与LVGLS均有较强相关性(r=0.710、0.717,P均<0.01),LAScd与LAVI均有中等程度的相关性(r=-0.595、-0.522,P<0.05)。ROC曲线分析4D Auto LAQ参数曲线下面积最大的为LASr。结论4D Auto LAQ技术评估HCM患者左房功能变化,可早期发现左房功能受损及重构发生,且其与左室重构密切相关,可为HCM患者预后及危险分层提供参考指标。

Objective To evaluate the application value of left atrial function in patients with hypertrophic cardiomyopathy(HCM)by four-dimensional automatic left atrial quantitation(4D Auto LAQ)technology.Methods Forty patients with HCM(20 obstructive cases,20 non-obstructive cases)and 20 healthy people(control group)who were treated in the First Affiliated Hospital of Zhengzhou University from March to December 2021 were selected.The application of 4D Auto LAQ software was used to obtain the maximum left atrial volume(LAV_(max)),minimum left atrial volume(LAV_(min)),left atrial pre-systolic volume(LAVpre),left atrial volume index(LAVI),left atrial reserve longitudinal strain(LASr),left atrial reservoir circumferential strain(LASr-c),left atrial conduit longitudinal strain(LAScd),left atrial passage circumferential strain(LAScd-c),left atrial systolic longitudinal strain(LASct),left atrial systolic circumferential strain(LASct-c),left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),and the left atrial total emptying fraction(LAtEF),left atrial passive emptying fraction(LApEF)and left atrial active emptying fraction(LAaEF)were calculated.The differences of parameters in each group were compared.Spearman correlation analysis was used to analyze the correlation between left atrial function and left ventricular function.Receiver operating characteristic(ROC)curve was drawn to compare the accuracy of each 4D Auto LAQ parameter in the diagnosis of left atrial dysfunction in HCM patients.The intra-observer and inter-observer repeatability test of 4D Auto LAQ parameters was performed.Results Compared with the control group,LAV_(max),LAV_(min),LAVpre and LAVI in the obstructive HCM group and the non-obstructive HCM group were increased,and LASr,LASr-C,LAScd-C,LASct,LAtEF,LApEF and LVGLS were decreased(P<0.05).Compared with the non-obstructive HCM group,LAV_(max),LAV_(min),LAVpre,LAVI were increased,LAScd was decreased in the obstructive HCM group(P<0.05).Spearman correlation analysis showed that there was a strong correlation between LASr and LVGLS in the obstructive HCM group and the non-obstructive HCM group(r=0.710,0.717,P<0.01).LAScd was moderately correlated with LAVI(r=-0.595,-0.522,P<0.05).ROC curve analysis showed that the largest area under the 4D Auto LAQ parameter curve was LASr.Conclusion 4D Auto LAQ technology can evaluate left atrial function in patients with HCM,which can early detect left atrial remodeling and function impairment,and it is closely related to left ventricular remodeling,and provide reference indicators for the prognosis and risk stratification of HCM patients.