左房自动功能成像技术对射血分数保留型心衰患者左房功能的评估价值

Evaluation value of left atrial automated functional imaging on left atrial function in patients with heart failure with preserved ejection fraction

目的 左房自动功能成像技术对射血分数保留型心衰(HFpEF)患者左房功能的评估价值。方法 收集符合HFpEF诊断的73例患者(HFpEF组),记录其N末端B型利钠肽原(NT-proBNP)值;以同期68例门诊体检健康者作为对照组;根据左房最大容积指数(LAVImax)将HFpEF组患者分为A、B两组,LAVImax<34 mL/m2为A组,LAVImax≥34 mL/m2为B组,采集心尖四腔心及心尖两腔心连续至少3个心动周期动态图像,通过左房自动功能成像(LAAFI)描记左房心肌轮廓获得左房三期应变指标[储存期应变(LASr)、管道期应变(LAScd)及收缩期应变(LASct)]以及左房应变衍生参数[左心房充盈指数(LA filling index)、左心房僵硬指数(LA stiffness index)],分析两组间左房三期应变指标及左房应变衍生参数的差异。结果 A、B两组LA stiffness index>对照组,LASr、LAScd、LASct增高(P<0.05);B组LA stiffness index、LA filling index高于A组,LASr、LAScd、LASct低于A组(P<0.05);左房应变及其衍生参数的效能受试者工作特征(ROC)曲线显示,LASr、LAScd及LA stiffness index预测HFpEF的曲线下面积(AUC)相对较大,分别为0.927、0.910、0.922,截断值为34.5%、-18.5%、0.28,敏感性为80.82%、84.93%、79.45%,特异性为95.59%、77.94%、91.18%;左房应变相关参数与NT-proBNP的相关性分析显示,LASr与NT-proBNP呈负相关(r=-0.279,P<0.05),LA stiffness index与NT-proBNP呈正相关(r=0.423,P<0.05)。结论 左房应变及其衍生参数可无创定量评估HFpEF患者的左房功能障碍。

Objective To evaluate value of left atrial(LA)automated functional Imaging(AFILA)on LA function in patients with heart failure with preserved ejection fraction(HFpEF).Methods A total of 73 patients who met the diagnosis of HFpEF(HFpEF group)were collected.N-terminal prohormone of brain natriuretic peptide(NT-proBNP)values were documented.During the same period,68 healthy individuals who underwent outpatient physical examinations were selected as a control group.According to maximal LA volume index(LAVImax),the patients with HFpEF were divided into two groups:A group(LAVImax<34 mL/m 2)and B group(LAVImax≥34 mL/m 2).Dynamic images of the apical four chamber view of the hearts and the apical two chamber view of the hearts were collected at least three consecutive cardiac cycles.AFILA was applied to capture the contours of LA myocardium to obtain three phrase indexes[strain during reservoir phase(LASr),strain during conduit phase(LAScd)and strain during contraction phase(LASct)]as well as left atrial strain-derived parameters[left atrial filling index(LAFI),left atrial stiffness index(LASI)].The differences in strain indexes and LA strain-derived parameters during LA three strain phases were analyzed between two groups.Results LAFIs were greater in A and B groups than that in control group,and LASr,LAScd and LASct were increased(P<0.05).LAFI and LASI were higher in B group than those in A group,while LASr,LAScd and LASct were lower in B group than those in A group(P<0.05).Receiver operating characteristic(ROC)curves of LA strain and its derived parameters showed that the areas under curves(AUCs)of LASr,LAScd and LFSI for predicting HFpEF were 0.927,0.910,and 0.922,respectively,with the cutoffs of 34.5%,-18.5%,0.28,the sensitivities of 80.82%,84.93%,and 79.45%,their specificities of 95.59%,77.94%,and 91.18%,respectively.The correlation analysis of LA strain-related parameters and NT-proBNP showed that LASr was negatively correlated with NT-proBNP(r=-0.279,P<0.05),and LASI was positively correlated with NT-proBNP(r=0.423,P<0.05).Conclusion LA strain and its derived parameters can be used for non-invasively quantitative assessing LA dysfunction in patients with HFpEF.