基于四维左房自动定量技术的高尿酸血症患者左房功能研究

Study of Left Atrial Function in Hyperuricemia Patients Based on Four-Dimensional Left Atrial Automatic Quantification

目的采用四维左房自动定量(Four-Dimensional Left Atrial Automatic Quantification,4D LAQ)技术研究高尿酸血症患者左房心肌力学的改变,并定量评价其左房早期重塑特点。方法随机选取2022年6—12月于我院就诊的高尿酸血症患者86例和健康对照者35例。在常规二维超声心动图(Two-Dimensional Echocardiography,2DE)检查的基础上,应用4D LAQ技术研究受检者左房心肌力学改变。通过4D LAQ获取心室收缩期、舒张早期和舒张晚期左房心肌整体纵向应变(LASr、LAScd、LASct)及环向应变(LASr_c、LAScd_c、LASct_c),同时获得左房最大容积(Left Atrial Maximum Volume,LAVmax)和左房最大容积指数(Index of LAVmax,LAVmaxI);通过2DE获取左房前后径(Left Atrial Anteroposterior Diameter,LAD)、左室舒张末内径(Left Ventricular End-Diastolic Diameter,LVEDD)、左室短轴缩短分数(Left Ventricular Fractional Shortening,FS)、左室射血分数(Left Ventricular Ejection Fraction,LVEF)、每搏量(Stroke Volume,SV)以及二尖瓣口舒张早期与晚期峰值血流速度之比(E/A)。按照LAVmaxI值,将50例LAVmaxI<34 mL/m2的高尿酸血症患者作为试验组(高尿酸血症组),35例健康者作为对照组。结果与对照组相比,高尿酸血症组患者LASr_c、LAScd_c及E/A显著减小(P<0.001),LASr、LAScd、LASct、LASct_c、LAVmax、LAVmaxI及常规二维参数LAD、LVEDD、FS、LVEF、SV无明显差异(P>0.05)。患者血尿酸水平与LASr_c(r=-0.68,P<0.001)、LAScd_c(r=0.72,P<0.001)及E/A(r=-0.74,P<0.001)均存在相关性,而与LASr、LAScd、LASct、LASct_c、LAVmax、LAVmaxI、LAD、LVEDD、FS、LVEF、SV、年龄、血糖、血脂和血胆固醇无显著相关性(P>0.05)。结论4D LAQ可有效评价高尿酸血症患者早期左房心肌力学变化,尤其是左房环向应变,可为临床综合评价高尿酸血症患者情况提供新方法。

Objective To study the mechanical changes of the left atrial myocardium in hyperuricemia patients using four-dimensional left atrial automatic quantification(4D LAQ)and to quantitatively evaluate the early remodeling characteristics of the left atrium.Methods A total of 86 hyperuricemia patients and 35 healthy controls were randomly selected in our hospital from June to December 2022.The 4D LAQ was used to study the deformation characteristics of the left atrial myocardium on the basis of conventional two-dimensional echocardiography(2DE).Global longitudinal strain(LASr、LAScd、LASct)and circumferential strain(LASr_c、LAScd_c、LASct_c)values of the left atrium myocardium during ventricular systolic,early diastolic and late diastolic phase were obtained by 4D LAQ,and the left atrial maximum volume(LAVmax)and LAVmax index(LAVmaxI)were acquired at the same time.The left atrial anteroposterior diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular fractional shortening(FS),left ventricular ejection fraction(LVEF),stroke volume(SV),and the ratio of peak flow velocity during early and late diastolic of mitral valve(E/A)were measured by 2DE.According to the LAVmaxI value,50 hyperuricemia patients with LAVmaxI<34 mL/m2 were selected as the experimental group(hyperuricemia group),and 35 healthy individuals were selected as the control group.Results Compared with the control group,LASr_c,LAScd_c and E/A were significantly decreased in the hyperuricemia group(P<0.001).There was no significant difference in LASr,LAScd,LASct,LASct_c,LAVmax,LAVmaxI,and conventional two-dimensional parameters including LAD,LVEDD,FS,LVEF,and SV(P>0.05).Patient blood uric acid level were associated with LASr_c(r=-0.68,P<0.001),LAScd_c(r=0.72,P<0.001)and E/A(r=-0.74,P<0.001),but was no significant association with LASr,LAScd,LASct,LASct_c,LAVmax,LAVmaxI,LAD,LVEDD,FS,LVEF,SV,age,blood glucose,blood lipid,and blood cholesterol(P>0.05).Conclusion The 4D LAQ technology can effectively evaluate the early left atrial myocardial mechanical changes in patients with hyperuricemia,especially the left atrial circumferential strain,provides a new method for clinical comprehensive evaluation of the condition of hyperuricemia patients.