四维自动左房定量技术评价冠心病患者左房功能预测左室重构的应用价值

Evaluation of left atrial function in predicting left ventricular remodeling in patients with coronary heart disease by four dimensional automatic left atrial quantitation analysis technique

目的应用四维自动左房定量(4D Auto LAQ)技术评估冠心病(CHD)患者左房功能以及预测发生左室重构的价值。方法前瞻性选取2021年10月至2022年9月就诊于阜外华中心血管病医院CHD患者176例。根据左室质量指数分为2组,即左室重构组(女性>95 g/m^(2),男性>115 g/m^(2),n=88)和左室非重构组(女性≤95 g/m^(2),男性≤115 g/m^(2),n=88)。应用4D Auto LAQ技术在机分析左房三维动态图像获取左房参数,包括左房最小、最大、收缩前及排空容积(LAVmin、LAVmax、LAVpreA、LAEV)、左房射血分数(LAEF)、左房储存期纵向及圆周应变(LASr、LASr-c)、左房管道期纵向及圆周应变(LAScd、LAScd-c)和左房收缩期纵向及圆周应变(LASct、LASct-c)。采用Logistic回归模型分析左房参数在CHD患者发生左室重构的预测价值。采用ROC曲线评估左房参数、左房容积指数(LAVI)预测左室重构的诊断效能。结果与左室非重构组比较,左室重构组LAVmin、LAVmax、LAVpreA增大,LAEF、LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c减小(均P<0.05)。Logistic回归模型在调整临床一般资料、超声参数后显示,LASct-c是影响CHD患者左室重构的独立风险因素(OR=2.018,95%CI=1.214~3.355)。ROC曲线分析显示,LASct-c可用于预测CHD患者左室重构的曲线下面积0.844,敏感性0.784,特异性0.761。结论4D Auto LAQ技术可定量评估CHD患者左房功能,LASct-c可作为预测CHD患者发生左室重构的参考指标,为CHD患者预后评估提供一种新的评价方法。

Objective To evaluate left atrial(LA)function and its value in predicting left ventricular(LV)remodeling in patients with coronary heart disease(CHD)by four dimensional automatic left atrial quantitation(4D Auto LAQ).Methods A total of 176 patients with CHD were prospectively enrolled in Fuwai Central China Cardiovascular Hospital from October 2021 to September 2022.They were divided into two groups according to left ventricular mass index:LV remodeling group(female>95 g/m^(2),male>115 g/m^(2),n=88)and Non-LV remodeling group(female≤95 g/m^(2),male≤115 g/m^(2),n=88).The 3D dynamic image of LA was analyzed by 4D Auto LAQ on machine to obtain the LA parameters,including the minimum,maximum,pre-systolic and emptying volumes of LA(LAVmin,LAVmax,LAVpreA,LAEV),LA ejection fraction(LAEF),LA reservoir longitudinal and circumferential strains(LASr,LASr-c),LA conduit longitudinal and circumferential strains(LAScd,LAScd-c)and LA contraction longitudinal and circumferential strains(LASct,LASct-c).Logistic regression models were used to analyze the value of LA parameters in predicting LV remodeling in patients with CHD.ROC curve was used to evaluate LA parameters and left atrial volume index(LAVI)to predict the diagnostic efficiency of LV remodeling.Results Compared with the Non-LV remodeling group,LAVmin,LAVmax,LAVpreA were significantly increased and LAEF,LASr,LAScd,LASct,LASr-c,LAScd-c,LASct-c were significantly decreased in the LV remodeling group(P<0.05).Logistic regression model showed that LASct-c was an independent risk factor for LV remodeling in patients with CHD after adjustment(OR=2.018,95%CI=1.214-3.355).ROC curve analysis showed that the area under the curve of LASct-c for predicting LV remodeling in CHD patients was 0.844,the sensitivity was 0.784,and the specificity was 0.761.Conclusions 4D Auto LAQ can effectively evaluate LA function in patients with CHD.LASct-c can be used as a reference index to predict LV remodeling in patients with CHD,which provides a new evaluation method in prognosis evaluation of CHD patients.