四维自动左房定量分析技术评价妊娠期高血压疾病患者左心房功能及其危险分层预测

Evaluation of left atrial function and predictive value of risk stratification in patients with hypertensive disorder of pregnancy by four-dimensional automatic left atrial quantitative analysis

目的采用四维自动左房定量分析(4D LAQ)技术探讨妊娠期高血压疾病(HDPs)左房容积和功能变化特点及其危险分层的预测价值。方法随机选取2021年3-12月于河南省人民医院确诊为HDPs的患者60例作为病例组,根据病情发展及文献报道的危险分层方法进行分组,分为妊娠期高血压组(即低危组,30例)和子痫前期组(即中高危组,30例);另选取年龄、孕周、体质指数与病例组相匹配的健康孕妇30例作为对照组。常规测量左房前后径(LAd)、室间隔厚度(IVSd)、左室舒张末期内径(LVd)、左室射血分数(LVEF)、左室心肌质量指数(LVMI)、二尖瓣口血流舒张早期(E)及舒张晚期(A)峰值速度、二尖瓣环间隔侧及侧壁侧e′值,计算E/A、E/e′。应用4D LAQ技术获取左房容积和应变参数,包括左房最小容积(LAVmin)、左房最大容积(LAVmax)、左房收缩前容积(LAVpreA)、左房最大容积指数(LAVImax)、左房膨胀指数(LAEI)、左房每搏量(LAEV)、左房射血分数(LAEF),左房储备期、管道期及收缩期纵向应变(LASr、LAScd、LASct),左房储备期、管道期及收缩期圆周应变(LASr-c、LAScd-c、LASct-c)。比较三组间以上指标的差异。采用多元Logistics回归分析得出HDPs危险分层的相关指标并采用ROC曲线进行评估。结果与对照组相比,妊娠期高血压组E/e′、LAVmin、LAVpreA、LAScd、LAScd-c增大,LAEI、LAEF、LApEF、LASr、LASr-c减小(均P<0.05);子痫前期组较对照组与妊娠高血压组LAd、IVSd、LVd、LVMI、E/e′、LAVmin、LAVmax、LAVpreA、LAVImax、LAEV、LAScd、LAScd-c增大,LVEF、LAEF、LAEI、LApEF、LASr、LASr-c减小,差异有统计学意义(均P<0.05)。多元Logistics回归结果显示LAVmax、LAScd-c、LASr为HDPs危险分层相关指标(β分别为0.344、0.216、-0.249,均P<0.05)。ROC分析显示在预测HDPs病情严重程度时,LASr截断值为30.5%时,敏感性和特异性分别为0.58和0.90,曲线下面积(AUC)为0.725;LAVmax截断值为44.5 ml时,敏感性和特异性分别为0.80和0.56,AUC为0.662;LAScd-c截断值为-17.5%时,敏感性和特异性分别为0.56和0.78,AUC为0.706。结论HDPs患者左心房发生重塑,其储备与管道功能均受损,且随病情进展加重。左房四维参数LASr、LAVmax、LAScd-c为HDPs危险分层的相关指标。在预测HDPs病情严重程度时,LASr有较高的诊断价值和较好的特异性,LAVmax、LAScd-c可考虑作为预测HDPs危险分层的补充参数。

Objective To investigate the change of left atrial volume and function in patients with hypertensive disorders of pregnancy(HDPs)by four-dimensional automatic left atrial quantitative analysis(4D LAQ)and analyze the predictive value of risk stratification.Methods A total of 60 patients diagnosed with hypertensive disorder of pregnancy in Henan Provincial People's Hospital from March to December 2021 were randomly enrolled,which were divided into gestational hypertension group(low risk group,n=30)and preeclampsia group(medium and high risk group,n=30)according to the disease development and risk stratification method reported in the literature;another 30 healthy pregnant women matched for age,gestational weeks and body mass index were selected as the control group.Left atrial anteroposterior diameter(LAd),interventricular septum thickness(IVSd),left ventricular end diastolic diameter(LVd),left ventricular ejection fraction(LVEF),left ventricular myocardial mass index(LVMI),peak early diastolic(E)and late diastolic(A)velocities of mitral inflow,and e'values on the septal and lateral mitral annulus sides were routinely measured to calculate E/A and E/e'values.Left atrial volume and strain parameters were obtained using 4D LAQ technique,including left atrial minimum volume(LAVmin),left atrial maximum volume(LAVmax),left atrial presystolic volume(LAVpreA),left atrial maximum volume index(LAVImax),left atrial inflation index(LAEI),left atrial stroke volume(LAEV),left atrial fraction(LAEF),longitudinal strain of left atrial reserve,conduit and systolic period(LASr,LAScd,LASct),circumferential strain of left atrial reserve,conduit and systolic period(LASr-c,LAScd-c,LASct-c).The differences among the three groups were compared.Multiple Logistics regression analysis was used to obtain the relevant indicators of risk stratification of HDPs and ROC curves were used for assessment.Results Compared with the control group,E/e',LAVmin,LAVpreA,LAScd,and LAScd-c increased,and LAEI,LAEF,LApEF,LASr,and LASr-c decreased in the gestational hypertension group(all P<0.05).Compared with the control group and gestational hypertension group,LAd,IVSd,LVd,LVMI,E/e'LAVmin,LAVmax,LAVpreA,LAVImax,LAEV,LAScd,and LAScd-c increased,and LVEF,LAEF,LAEI,LApEF,LASr,and LASr-c decreased in the preeclamptic group,and the differences were statistically significant(all P<0.05).The results of multiple Logistics regression showed that LAVmax,LAScd-c and LASr were the indicators relevant to risk stratification of HDPs(β=0.344,0.216 and-0.249,respectively,all P<0.05).ROC analysis showed when the cut-off value of left atrial strain parameter LASr was 30.5%,the AUC,sensitivity,and specificity were 0.725,0.58,0.90,respectively;when the cut-off value of LAVmax was 44.5 ml,the AUC,sensitivity,and specificity were 0.662,0.80,and 0.56,respectively;and when the cut-off value of LAScd-c was-17.5%,the AUC,sensitivity,and specificity were 0.706,0.56,and 0.78,respectively.Conclusions Left atrial remodeling occured in pregnant women with hypertensive disorders,their reserve and conduit function were impaired,and aggravated with the progress of the disease.The four-dimensional parameters LASr,LAVmax,and LAScd-c were relevant indicators for risk stratification of HDPs.In predicting the severity of HDPs,LASr has high diagnostic value and good specificity;LAVmax and LAScd-c can be considered as supplementary parameters to predict the risk stratification of HDPs.