二尖瓣狭窄伴房颤患者左心房应变参数与心功能、血浆NT-proBNP的相关性

Correlation of left atrial strain parameters with left ventricular function and plasma NT-proBNP in patients with mitral stenosis and atrial fibrillation

目的探讨二尖瓣狭窄伴房颤的患者左心房应变参数与心功能、血浆氨基末端脑钠肽前体(NT-proBNP)的相关性。方法选取我院2021年1月~2022年12月经心电图、心脏超声等方式确诊的74例二尖瓣狭窄伴房颤的患者作为病例组,选取经健康体检发现心脏结构及功能正常的志愿者80例作为对照组,采用超声心动图、心脏二维斑点追踪技术检测两组患者的心功能指标、左心房应变参数、血浆NT-proBNP,并采用Pearson线性相关分析法分析各项指标与左心房应变参数的关系。结果病例组患者的左心房前后径(LADS)、左心房后壁厚度(LVPWd)、室间隔厚度(IVSd)测定值高于对照组,左心室射血分数(LVEF)测定值低于对照组,差异具有统计学意义(P<0.05);两组左心房内径(LVDd)、二尖瓣口血流速度E值与A值之比(E/A)比较,差异均无统计学意义(P>0.05);病例组患者的左心房峰值应变(SLAs)、左心房峰值应变率(SRLAs)、左心房收缩期峰值应变(SLAac)、左心房收缩期峰值应变率(SRLAac)、左心房舒张早期峰值应变(SLAed)、左心房舒张早期峰值应变率(SRLAed)、左心房收缩期整体能量损耗(EL-S)、左心房舒张早期整体能量损耗(EL-D)测定值均低于对照组,差异具有统计学意义(P<0.05);病例组患者的NT-proBNP水平高于对照组,差异具有统计学意义(P<0.05);病例组患者的SLAs、SRLAs、SLAac、SRLAac、SLAed、SRLAed、EL-S、EL-D与LVPWd、IVSd呈负相关(P<0.05),与LVEF呈正相关(P<0.05),与NT-proBNP无明显相关性(P>0.05)。结论二尖瓣狭窄伴房颤的患者左心房应变能力减弱,与患者左心房重构、心功能减低有一定的相关性。

Objective To investigate the correlation between left atrial strain parameters and left ventricular function,plasma amino terminal brain natriuretic peptide precursor(NT-proBNP)in patients with mitral stenosis and atrial fibrillation.Methods Seventy-four patients with mitral stenosis and atrial fibrillation diagnosed by electrocardiogram and echocardiography in our hospital from Jan 2021 to Dec 2022 were selected as the case group,and 80 healthy volunteers with normal hearts were selected as control group.Cardiac function indexes,left atrial strain parameters and plasma NT-proBNP of the two groups were detected by echocardiography and two-dimensional heart spot tracking technology,and the relationship between all indexes and left atrial strain parameters was analyzed by Pearson linear correlation analysis.Results The values of LADS,LVPWd and IVSd in the case group were higher than those in the control group,while the values of LVEF were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in E/A between the two groups(P>0.05).The values of SLAs,SRLAs,SLAac,SRLAac,SLAed,SRLAed,EL-S and EL-D in the case group were lower than those in the control group,and the differences were statistically significant(P<0.05).The level of NTproBNP in the case group was lower than that in the control group,and the difference was statistically significant(P<0.05).In the case group,SLAs,SRLAs,SLAac,SRLAac,SLAed,SRLAed,EL-S and EL-D were significantly negatively correlated with LVPWd and IVSd(P<0.05),and were significantly positively correlated with LVEF(P<0.05).Conclusion The left atrial strain capacity is weakened in patients with mitral stenosis and atrial fibrillation,which is related to left atrial remodeling and reduced cardiac function.