二维斑点追踪超声心动图评估慢性心力衰竭患者左心房心肌力学变化

Two-dimensional speckle tracking echocardiography in evaluating left atrial myocardial mechanical changes in patients with chronic heart failure

目的 观察慢性心力衰竭患者左心房心肌力学变化,探讨二维斑点追踪超声心动图(2D-STE)对其的评估作用。方法 2022年10月—2023年12月郑州大学第一附属医院诊治慢性全心衰竭(CBHF)患者87例(CBHF组)和慢性左心衰竭(CLHF)患者85例(CLHF组),均行常规超声心动图检查,平静状态下采集连续5个心动周期的二维灰阶动态图像。于局部放大的胸骨旁左心室长轴切面上,参照心电图,测量二尖瓣环与主动脉瓣环平面最大夹角(AMAmax)和最小夹角(AMAmin),计算角度变化率。采用Simpson’s双平面法测量左室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心房容积指数(LAVi),测量室间隔侧电-机械传导时间(TIVS P-a)、侧壁侧电-机械传导时间(TLW P-a)、舒张期二尖瓣口前向血流速度E峰、A峰及舒张早期运动峰值速度e’,计算E/e’,并评估二尖瓣反流程度。应用超声定量分析软件获取左心室整体纵向应变(LVGLS)及左心房储存期应变(LASr)、管道期应变(LAScd)、收缩期应变(LASct)。采用多元线性回归分析CBHF、CLHF患者LASr、LASct的影响因素,采用Pearson法或Spearman法分析2组LASr、LASct与LVGLS、LAVi的相关性。结果 CBHF组收缩压[127.00(115.01,139.11)mmHg]低于CLHF组[132.00(122.12,142.30)mmHg](Z=-2.143,P=0.032),TLW P-a[45.00(32.00,57.00)ms]长于CLHF组[30.00(26.00,39.00)ms](Z=-3.749,P<0.001),LVESV[174.00(147.29,204.55)mL]、LAVi[(64.85±1.72)mL/m^(2)]均大于CLHF组[164.00(143.50,182.00)mL、(57.98±1.54)mL/m^(2)](Z=-2.156,P=0.031;t=2.967,P=0.003),二尖瓣反流中、重度比率(42.53%、34.48%)高于CLHF组(36.47%、17.65%)(χ^(2)=7.493,P=0.007;χ^(2)=8.763,P=0.007),体质量指数、心率、舒张压、E峰、A峰、E/e’、TIVS P-a、AMAmax、AMAmin、角度变化率、LVEF、LVEDV及高血压、糖尿病比率与CLHF组比较差异均无统计学意义(P>0.05)。CBHF组LVGLS[(-7.00±0.00)%]、LASr[8.00(6.00,10.00)%]、LASct[(-2.00±0.00)%]绝对值均低于CLHF组[(-8.00±0.00)%、9.80(7.60,12.30)%、(-4.00±0.00)%](P<0.05),LAScd绝对值与CLHF组比较差异无统计学意义(P>0.05)。LVGLS是CBHF、CLHF患者LASr的影响因素(β=-0.430,95%CI:-0.771~-0.088,P=0.014;β=-0.304,95%CI:-0.605~-0.003,P=0.048),LAVi、LVGLS是CLHF患者LASct的影响因素(β=0.001,95%CI:0.000~0.001,P=0.004;β=0.285,95%CI:0.065~0.506,P=0.012)。CBHF组、CLHF组LASr与LVGLS均呈负相关(r=-0.321,P=0.005;r=-0.217,P=0.046),CLHF组LASct与LAVi、LVGLS均呈正相关(r=0.246,P=0.023;r=0.228,P=0.036)。结论 CBHF患者LAVi增高,二尖瓣环TLW P-a延长,LASr随LVGLS增大而降低;2D-STE可评估慢性心力衰竭患者左心房心肌力学变化。

Objective To observe the left atrial myocardial mechanical changes in patients with chronic heart failure,and to explore the predictive role of two-dimensional speckle tracking echocardiography(2D-STE).Methods Totally 87 patients with chronic whole heart failure(CBHF)(CBHF group)and 85 patients with chronic left heart failure(CLHF)(CLHF group)were treated in the First Affiliated Hospital of Zhengzhou University from October,2022 to December,2023.All patients underwent routine echocardiography,and two-dimensional gray-scale dynamic images were collected for five consecutive cardiac cycles in a calm state.On the partially enlarged long-axis section of the parasternal left ventricle,the maximum angle(AMAmax)and minimum angle(AMAmin)were measured with reference to the electrocardiogram,and the rate of angle change was calculated.Simpson's biplane method was used to measure the left ventricular ejection fraction(LVEF);left ventricular end-diastolic volume(LVEDV);left ventricular end-systolic volume(LVESV);left atrial volume index(LAVi);interventricular septum time P-a(TIVS P-a);lateral wall time P-a,(TLW P-a);diastolic mitral valve orifice forward blood flow velocity E peak,A peak and early diastolic peak velocity e',the E/e'ratio was calculated,and the degree of mitral regurgitation was evaluated.Ultrasound quantitative analysis software was used to obtain left ventricular global longitudinal strain(LVGLS);left atrial reservoir strain(LASr);left atrial conduit strain(LAScd)and left atrial contraction strain(LASct).Multiple linear regression was used to analyze the influencing factors of LASr and LASct in patients with CBHF and CLHF.Pearson method or Spearman method was used to analyze the correlations of LASr and LASct with LVGLS and LAVi in two groups.Results The systolic blood pressure was lower in CBHF group[127.00(115.01,139.11)mmHg]than that in CLHF group[132.00(122.12,142.30)mmHg](Z=-2.143,P=0.032).The TLW P-a was longer in CBHF group[45.00(32.00,57.00)ms]than that in CLHF group[30.00(26.00,39.00)ms](Z=-3.749,P<0.001).LVESV and LAVi were greater in CBHF group[174.00(147.29,204.55)mL,(64.85±1.72)mL/m^(2)]than those in CLHF group[164.00(143.50,182.00)mL,(57.98±1.54)mL/m^(2)](Z=-2.156,P=0.031;t=2.967,P=0.003).The rates of moderate and severe mitral regurgitation were higher in CBHF group(42.53%,34.48%)than those in CLHF group(36.47%,17.65%)(χ^(2)=7.493,P=0.007;χ^(2)=8.763,P=0.007).There were no significant differences in the body mass index,heart rate,diastolic blood pressure,E peak,A peak,E/e'ratio,TIVS P-a,AMAmax,AMAmin,angle change rate,LVEF,LVEDV and proportions of hypertension and diabetes between two groups(P>0.05).The absolute values of LVGLS,LASr and LASct were lower in CBHF group[(-7.00±0.00)%,8.00(6.00,10.00)%,(-2.00±0.00)%]than those in CLHF group[(-8.00±0.00)%,9.80(7.60,12.30)%,(-4.00±0.00)%](P<0.05);and there was no significant difference in the absolute value of LAScd between two groups(P>0.05).LVGLS was an influencing factor of LASr in both two groups(β=-0.430,95%CI:-0.771 to-0.088,P=0.014;β=-0.304,95%CI:-0.605 to-0.003,P=0.048).LAVi and LVGLS were the influencing factors of LASct in CLHF group(β=0.001,95%CI:0.000-0.001,P=0.004;β=0.285,95%CI:0.065-0.506,P=0.012).In CBHF group and CLHF group,LASr was negatively correlated with LVGLS(r=-0.321,P=0.005;r=-0.217,P=0.046).In CLHF group,LASct was positively correlated with LAVi and LVGLS(r=0.246,P=0.023;r=0.228,P=0.036).Conclusion In CBFH patients,LAVi increases,TLW P-a in the mitral annulus prolongs,and LASr decreases with the increase of LVGLS,therefore 2D-STE can be used to evaluate left atrial myocardial mechanical changes in patients with chronic heart failure.