左心房容积指数与左心房前后径评价左心室舒张功能的一致性

Consistency of evaluating left ventricular diastolic function using left atrial volume index and left atrial anteroposterior diameter

目的探讨左心房容积指数(LAVI)与左心房前后径(LAAP)的关系以及二者评价左心室舒张功能的一致性。方法选取我院2018年7月至2019年12月进行超声心动图检查患者315例,其中健康者68例(21.6%),高血压患者98例(31.1%),冠状动脉粥样硬化性心脏病患者97例(30.8%),扩张型心肌病患者32例(10.2%),肺源性心脏病患者11例(3.5%),先天性心脏病患者9例(2.9%)。收集患者临床一般资料,超声心动图检测患者各项心脏指标,包括LAAP、左心房容积(LAV)、二尖瓣舒张早期峰值血流速度(MV E)、二尖瓣舒张晚期峰值血流速度(MV A)、二尖瓣环室间隔部位舒张早期峰值速度(Septal e’)、二尖瓣环侧壁部位舒张早期峰值速度(Lateral e’)、三尖瓣反流峰速(TR)、左心室射血分数(LVEF)等。根据LVEF分为LVEF正常组(LVEF≥53%,n=264)和LVEF减低组(LVEF<53%,n=51),采用独立样本t检验比较2组左心室舒张功能指标的差异。采用Pearson或Spearman相关分析LAVI与LAAP的相关性;采用Kappa检验分析LAAP和LAVI评价左心室舒张功能的一致性。结果与LVEF正常组比较,LVEF减低组患者LAAP、LAV、LAVI、E/e’及TR显著增大(均P<0.001),而Septal e’及Lateral e’显著减小(均P<0.001)。LAAP和LAVI水平呈正相关(r=0.74,P<0.001)。LAAP和LAVI评价左心室舒张功能是否减低及分级的一致性均较强(均P<0.001)。结论LAAP与LAVI水平呈正相关;LAAP与LAVI评价左心室舒张功能是否减低和分级时一致性均较强。LVEF减低时,LAAP与LAVI相关性更高,LAAP与LAVI评价左心室舒张功能分级的一致性更强。因此,对于LVEF减低患者,当无法获得LAVI指标时,可用LAAP替代LAVI进行评估。

Objective To investigate the relationship between the left atrial volume index(LAVI)and left atrial anteroposterior diameter(LAAP)and their consistency in evaluating left ventricular diastolic function.Methods The study enrolled 315 patients who underwent echocardiography in our hospital between July 2018 and December 2019,including 68 healthy patients(21.6%),98 patients with hypertension(31.1%),97 patients with atherosclerotic heart disease(30.8%),32 patients with dilated cardiomyopathy(10.2%),11 patients with pulmonary heart disease(3.5%),and nine patients with congenital heart disease(2.9%).General clinical data were collected,and echocardiography was performed to detect various cardiac indicators,including LAAP,left atrial volume(LAV),mitral inflow-early diastolic(MV E),mitral inflow-late diastolic,septal early diastolic mitral annulus peak velocity(Septal e’),lateral early diastolic mitral annulus peak velocity(Lateral e’),tricuspid regurgitation peak velocity,and left ventricular ejection fraction(LVEF).Patients were divided into a normal LVEF group(LVEF≥53%,n=264)and a reduced LVEF group(LVEF<53%,n=51).An independent sample t test was used to compare the parameters of left ventricular diastolic function between the two groups.The correlation between LAVI and LAAP was analyzed using Pearson or Spearman correlation analysis.The kappa test was used to analyze the consistency of LAAP and LAVI in evaluating left ventricular diastolic function.Results LAAP,LAV,LAVI,MV E/e’,and TR were significantly higher in the reduced LVEF group than in the normal LVEF group(all P<0.001),while Septal and Lateral e’were significantly decreased(all P<0.001).LAAP and LAVI were positively correlated(r=0.74,P<0.001).The results of the LAAP and LAVI evaluations of left ventricular diastolic function in all patients and groups showed that LAAP and LAVI were consistent in evaluating whether left ventricular diastolic function was reduced and graded(P<0.001 for all).Conclusion LAAP and LAVI measured by echocardiography were positively correlated and showed strong consistency in evaluating whether left ventricular diastolic function was reduced and graded.The correlation between LAAP and LAVI was higher when the LVEF was reduced,and the consistency of LAAP and LAVI in evaluating left ventricular diastolic function was stronger.Therefore,in patients with a reduced LVEF,LAAP can be used instead of LAVI for evaluation when LAVI indicators cannot be obtained.