Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tra...Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tracking （EAT）.展开更多
Background In an effort to avoid x-ray and contrast agents for patients of atrial fibrillation(AF)with chronic kidney disease,we developed a method for transcatheter closure of left atrial appendage(LAA)under the guid...Background In an effort to avoid x-ray and contrast agents for patients of atrial fibrillation(AF)with chronic kidney disease,we developed a method for transcatheter closure of left atrial appendage(LAA)under the guidance of transesophageal echocardiography(TEE)without fluoroscopy.展开更多
The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV s...The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.展开更多
BACKGROUND The prevalence of left atrial appendage(LAA) thrombus detection by transesophageal echocardiogram(TEE) in patients with non-valvular atrial fibrillation(AF) anticoagulated with apixaban is not well defined ...BACKGROUND The prevalence of left atrial appendage(LAA) thrombus detection by transesophageal echocardiogram(TEE) in patients with non-valvular atrial fibrillation(AF) anticoagulated with apixaban is not well defined and identification of additional risk factors may help guide the selection process for pre-procedural TEE. The purpose of our study was to retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban for ≥ 4 wk and evaluate for any cardiac risk factors or echocardiographic characteristics which may serve as predictors of thrombus formation.AIM To retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban.METHODS Clinical and echocardiographic data for 820 consecutive patients with AF undergoing TEE at Augusta University Medical Center over a four-year period were retrospectively analyzed. All patients(apixaban: 226) with non-valvular AF and documented compliance with apixaban for ≥ 4 wk prior to index TEE were included.RESULTS Following ≥ 4 wk of continuous anticoagulation with apixaban, the prevalence ofLAA thrombus and LAA thrombus/dense spontaneous echocardiographic contrast was 3.1% and 6.6%, respectively. Persistent AF, left ventricular ejection fraction < 30%, severe LA dilation, and reduced LAA velocity were associated with thrombus formation. Following multivariate logistic regression, persistent AF(OR: 7.427; 95%CI: 1.02 to 53.92; P = 0.0474), and reduced LAA velocity(OR:1.086; 95%CI: 1.010 to 1.187; P = 0.0489) were identified as independent predictors of LAA thrombus. No Thrombi were detected in patients with a CHA2 DS2-VASc score ≤ 1.CONCLUSION Among patients with non-valvular AF and ≥ 4 wk of anticoagulation with apixaban, the prevalence of LAA thrombus detected by TEE was 3.1%. This suggests that continuous therapy with apixaban does not completely eliminate the risk of LAA thrombus and that TEE prior to cardioversion or catheter ablation may be of benefit in patients with multiple risk factors.展开更多
Background The left atrial appendage （LAA） is an important source of thrombus formation. We investigated the feasibility of the recently developed real-time three-dimensional transesophageal echocardiography （RT3D-...Background The left atrial appendage （LAA） is an important source of thrombus formation. We investigated the feasibility of the recently developed real-time three-dimensional transesophageal echocardiography （RT3D-TEE） method in assessment of the morphology and function of the LAA. Methods Ninety-six consecutive patients （58 males with a mean age of （43.4±12.5） years） who were referred for 2-dimensional （2D） transesophageal echocardiography （TEE） underwent additional RT3D-TEE. LAA morphology was visualized in multiple views. Orifice size, depth, volumes and ejection fraction （EF） of the LAA, were measured. Results All the patients underwent RT3D-TEE examination without complications. Ninety-two patients （95.8%） had adequate images for visualization and quantitative analysis of the LAA. The LAA exhibited great variability with respect to relative dimensions and morphology. LAA orifice area was （3.8±1.2） cm^2 with a diameter of （2.4±0.9） cm x （1.4±0.6） cm. The mean depth of the LAA was （2.9±0.7） cm. End-diastolic volume （EDV-LAA）, end-systolic volume （ESV-LAA） and EF of the LAA were （6.2±3.7） ml, （4.1±2.8） ml, and 0.35±0.16, respectively. EDV-LAA, ESV-LAA and the orifice area of the LAA in patients with atrial fibrillation （AF） were larger than those without AF, whereas the EF was smaller in the AF patients. Conclusions Defining LAA morphology and quantitative analysis of the size and function of the LAA with superior quality and resolution of images using RT3D-TEE is feasible. This technique may be an ideal tool for guidance of the LAA occlusion procedure. Determination of LAA volumes and volume-derived EF by RT3D-TEE provides new insights into the analysis of LAA function.展开更多
Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thr...Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thrombus remains unclear.In this study,we sought to investigate the effect of MS on risk stratification of LA/LAA thrombus formation in patients with nonvalvular atrial fibrillation （NVAF）.Methods：This cross-sectional study enrolled 294 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapies.LA/LAA thrombus was determined by transesophageal echocardiography.Risk assessment of LA/LAA thrombus was performed using the CHADS2,CHA2DS2-VASc,MS,CHADS2-MS,and CHA2DS2-VASc-MS scores.Logistic regression analyses were performed to determine which factors were significantly related to LA/LAA thrombus.Odds ratio （OR） including 95% confidence interval was also calculated.The predictive powers of different scores for the risk of LA/LAA thrombus were represented by C-statistics and compared by receiver operating characteristic （ROC） analysis.Results：LA/LAA thrombi were identified in 56 patients （19.0%）.Logistic analysis showed that MS was the strongest risk factor for LA/LAA thrombus in NVAF patients （OR =14.698,P 〈 0.001）.ROC curve analyses revealed that the C-statistics of CHADS2-MS and CHA2DS2-VASc-MS was significantly higher than those of CHADS2 and CHA2DS2-VASc scores （CHADS2-MS vs.CHADS2,0.807 vs.0.726,P=0.0019）.Furthermore,MS was helpful for identifying individuals with a high risk of LA/LAA thrombus in the population with a low risk of stroke （CHADS2 or CHA2DS2-VASc score =0）.Conclusions：MS is associated with LA/LAA thrombus risk in patients with NVAF.In addition to the CHADS2 and CHA2DS2-VASc scores,the CHADS2-MS and CHA2DS2-VASc-MS scores provide additional information on stroke risk assessment.展开更多
BACKGROUND HeartModel(HM)is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function.This study used HM to quantify the left ventricular end-diastoli...BACKGROUND HeartModel(HM)is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function.This study used HM to quantify the left ventricular end-diastolic(LVEDV)and end-systolic volumes(LVESV)of patients with dilated cardiomyopathy(DCM),coronary artery heart disease with segmental wall motion abnormality,and hypertrophic cardiomyopathy(HCM)to determine whether there were differences in the feasibility,accuracy,and repeatability of measuring the LVEDV,LVESV,LV ejection fraction(LVEF)and left atrial end-systolic volume(LAESV)and to compare these measurements with those obtained with traditional twodimensional(2D)and three-dimensional(3D)methods.AIM To evaluate the application value of HM in quantifying left heart chamber volume and LVEF in clinical patients.METHODS A total of 150 subjects who underwent 2D and 3D echocardiography were divided into 4 groups:(1)42 patients with normal heart shape and function(control group,Group A);(2)35 patients with DCM(Group B);(3)41 patients with LV remodeling after acute myocardial infarction(Group C);and(4)32 patients with HCM(Group D).The LVEDV,LVESV,LVEF and LAESV obtained by HM with(HM-RE)and without regional endocardial border editing(HM-NE)were compared with those measured by traditional 2D/3D echocardiographic methods to assess the correlation,consistency,and repeatability of all methods.RESULTS(1)The parameters measured by HM were significantly different among the groups(P<0.05 for all).Compared with Groups A,C,and D,Group B had higher LVEDV and LVESV(P<0.05 for all)and lower LVEF(P<0.05 for all);(2)HM-NE overestimated LVEDV,LVESV,and LAESV with wide biases and underestimated LVEF with a small bias;contour adjustment reduced the biases and limits of agreement(bias:LVEDV,28.17 mL,LVESV,14.92 mL,LAESV,8.18 mL,LVEF,-0.04%).The correlations between HM-RE and advanced cardiac 3D quantification(3DQA)(r_(s)=0.91-0.95,P<0.05 for all)were higher than those between HM-NE(r_(s)=0.85-0.93,P<0.05 for all)and the traditional 2D methods.The correlations between HM-RE and 3DQA were good for Groups A,B,and C but remained weak for Group D(LVEDV and LVESV,r_(s)=0.48-0.54,P<0.05 for all);and(3)The intraobserver and interobserver variability for the HM-RE measurements were low.CONCLUSION HM can be used to quantify the LV volume and LVEF in patients with common heart diseases and sufficient image quality.HM with contour editing is highly reproducible and accurate and may be recommended for clinical practice.展开更多
Background: Recent observational studies have suggested that the patients with hyperuricemia have a higher risk of having left atrial thrombus (LATH) or left atrial spontaneous echo contrast (LASEC) by transesophageal...Background: Recent observational studies have suggested that the patients with hyperuricemia have a higher risk of having left atrial thrombus (LATH) or left atrial spontaneous echo contrast (LASEC) by transesophageal echocardiography (TEE), while the ultimate predictive value of a high uric acid (UA) level on LATH/LASEC remained obscure. Methods: We searched the PubMed and Cochrane clinical trials databases up to July 2015. Following screening the 369 initially identified studies, we analyzed six observational studies with 2381 patients. Results: The meta-analysis of these studies showed that an elevated serum UA level was associated with a higher likelihood of LATH/LASEC (OR ? 1.59, 95%CI 1.13e2.23, P ? 0.008), while significant differences exist among individual trials (P<0.00001 and I2 ? 85%). Sensitivity analysis failed to find any heterogeneity. Conclusion: An elevated UA level was associated with a higher risk of detecting a left atrial abnormality represented by LATH/LASEC.展开更多
目的应用四维自动左房定量技术(4D Auto LAQ)评价不同透析方式对尿毒症患者左房结构和功能的影响。方法选取于我院肾内科就诊的尿毒症患者80例,根据透析方式分为血液透析组39例和腹膜透析组41例,另选同期健康体检者35例作为正常对照组...目的应用四维自动左房定量技术(4D Auto LAQ)评价不同透析方式对尿毒症患者左房结构和功能的影响。方法选取于我院肾内科就诊的尿毒症患者80例,根据透析方式分为血液透析组39例和腹膜透析组41例,另选同期健康体检者35例作为正常对照组。应用常规超声心动图获取左室射血分数(LVEF)、左房内径(LAD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW);4D Auto LAQ获取左房应变参数,包括左房储备期纵向应变(LASr)、左房管道期纵向应变(LAScd)、左房收缩期纵向应变(LASct)、左房储备期环形应变(LASr-c)、左房管道期环形应变(LAScd-c)、左房收缩期环形应变(LASct-c),以及左房容积参数,包括左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房收缩前容积(LAVpreA)、左房射血分数(LAEF),比较各组上述参数的差异;分析LAEF与左房应变参数的相关性。结果①各组常规超声心动图参数比较:腹膜透析组和血液透析组LAD、LVEDD、IVS、LVPW均较正常对照组增大,差异均有统计学意义(均P<0.05);各组LVEF比较差异无统计学意义。②各组4D Auto LAQ左房应变参数比较:与正常对照组比较,腹膜透析组LASr、LAScd、LASr-c、LAScd-c均减小,LASct、LASct-c均增大,血液透析组LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c均减小,差异均有统计学意义(均P<0.05);除LAScd外,血液透析组LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c均较腹膜透析组减小,差异均有统计学意义(均P<0.05)。③各组4D Auto LAQ左房容积参数比较:与正常对照组比较,腹膜透析组LAVmax、LAVmin、LAVpreA均增大,LAEF减小,血液透析组LAVmax、LAVmin、LAVpreA均增大,LAEF减小,差异均有统计学意义(均P<0.05);与腹膜透析组比较,血液透析组LAVmax、LAmin、LAVpreA均增大,LAEF减小,差异均有统计学意义(均P<0.05)。④相关性分析显示,LAEF与LASr、LAScd、LASr-c、LAScd-c、LASct、LASct-c均呈正相关(r=0.531、0.522、0.705、0.686、0.306、0.376,均P<0.001)。结论4D Auto LAQ可用于评价不同透析方式对尿毒症患者左房结构和功能的影响,其中血液透析较腹膜透析对左房结构和功能影响更大。展开更多
基金Supported by the Natural Science Foundation of Liaoning ProvinceChina(2013023010)
文摘Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tracking （EAT）.
文摘Background In an effort to avoid x-ray and contrast agents for patients of atrial fibrillation(AF)with chronic kidney disease,we developed a method for transcatheter closure of left atrial appendage(LAA)under the guidance of transesophageal echocardiography(TEE)without fluoroscopy.
文摘The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.
文摘BACKGROUND The prevalence of left atrial appendage(LAA) thrombus detection by transesophageal echocardiogram(TEE) in patients with non-valvular atrial fibrillation(AF) anticoagulated with apixaban is not well defined and identification of additional risk factors may help guide the selection process for pre-procedural TEE. The purpose of our study was to retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban for ≥ 4 wk and evaluate for any cardiac risk factors or echocardiographic characteristics which may serve as predictors of thrombus formation.AIM To retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban.METHODS Clinical and echocardiographic data for 820 consecutive patients with AF undergoing TEE at Augusta University Medical Center over a four-year period were retrospectively analyzed. All patients(apixaban: 226) with non-valvular AF and documented compliance with apixaban for ≥ 4 wk prior to index TEE were included.RESULTS Following ≥ 4 wk of continuous anticoagulation with apixaban, the prevalence ofLAA thrombus and LAA thrombus/dense spontaneous echocardiographic contrast was 3.1% and 6.6%, respectively. Persistent AF, left ventricular ejection fraction < 30%, severe LA dilation, and reduced LAA velocity were associated with thrombus formation. Following multivariate logistic regression, persistent AF(OR: 7.427; 95%CI: 1.02 to 53.92; P = 0.0474), and reduced LAA velocity(OR:1.086; 95%CI: 1.010 to 1.187; P = 0.0489) were identified as independent predictors of LAA thrombus. No Thrombi were detected in patients with a CHA2 DS2-VASc score ≤ 1.CONCLUSION Among patients with non-valvular AF and ≥ 4 wk of anticoagulation with apixaban, the prevalence of LAA thrombus detected by TEE was 3.1%. This suggests that continuous therapy with apixaban does not completely eliminate the risk of LAA thrombus and that TEE prior to cardioversion or catheter ablation may be of benefit in patients with multiple risk factors.
文摘Background The left atrial appendage （LAA） is an important source of thrombus formation. We investigated the feasibility of the recently developed real-time three-dimensional transesophageal echocardiography （RT3D-TEE） method in assessment of the morphology and function of the LAA. Methods Ninety-six consecutive patients （58 males with a mean age of （43.4±12.5） years） who were referred for 2-dimensional （2D） transesophageal echocardiography （TEE） underwent additional RT3D-TEE. LAA morphology was visualized in multiple views. Orifice size, depth, volumes and ejection fraction （EF） of the LAA, were measured. Results All the patients underwent RT3D-TEE examination without complications. Ninety-two patients （95.8%） had adequate images for visualization and quantitative analysis of the LAA. The LAA exhibited great variability with respect to relative dimensions and morphology. LAA orifice area was （3.8±1.2） cm^2 with a diameter of （2.4±0.9） cm x （1.4±0.6） cm. The mean depth of the LAA was （2.9±0.7） cm. End-diastolic volume （EDV-LAA）, end-systolic volume （ESV-LAA） and EF of the LAA were （6.2±3.7） ml, （4.1±2.8） ml, and 0.35±0.16, respectively. EDV-LAA, ESV-LAA and the orifice area of the LAA in patients with atrial fibrillation （AF） were larger than those without AF, whereas the EF was smaller in the AF patients. Conclusions Defining LAA morphology and quantitative analysis of the size and function of the LAA with superior quality and resolution of images using RT3D-TEE is feasible. This technique may be an ideal tool for guidance of the LAA occlusion procedure. Determination of LAA volumes and volume-derived EF by RT3D-TEE provides new insights into the analysis of LAA function.
基金This study was supported by the National Natural Science Foundation project （No.81670364） and Natural Science Foundation of Guangdong Province （No. 2016A030313356）.
文摘Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thrombus remains unclear.In this study,we sought to investigate the effect of MS on risk stratification of LA/LAA thrombus formation in patients with nonvalvular atrial fibrillation （NVAF）.Methods：This cross-sectional study enrolled 294 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapies.LA/LAA thrombus was determined by transesophageal echocardiography.Risk assessment of LA/LAA thrombus was performed using the CHADS2,CHA2DS2-VASc,MS,CHADS2-MS,and CHA2DS2-VASc-MS scores.Logistic regression analyses were performed to determine which factors were significantly related to LA/LAA thrombus.Odds ratio （OR） including 95% confidence interval was also calculated.The predictive powers of different scores for the risk of LA/LAA thrombus were represented by C-statistics and compared by receiver operating characteristic （ROC） analysis.Results：LA/LAA thrombi were identified in 56 patients （19.0%）.Logistic analysis showed that MS was the strongest risk factor for LA/LAA thrombus in NVAF patients （OR =14.698,P 〈 0.001）.ROC curve analyses revealed that the C-statistics of CHADS2-MS and CHA2DS2-VASc-MS was significantly higher than those of CHADS2 and CHA2DS2-VASc scores （CHADS2-MS vs.CHADS2,0.807 vs.0.726,P=0.0019）.Furthermore,MS was helpful for identifying individuals with a high risk of LA/LAA thrombus in the population with a low risk of stroke （CHADS2 or CHA2DS2-VASc score =0）.Conclusions：MS is associated with LA/LAA thrombus risk in patients with NVAF.In addition to the CHADS2 and CHA2DS2-VASc scores,the CHADS2-MS and CHA2DS2-VASc-MS scores provide additional information on stroke risk assessment.
文摘BACKGROUND HeartModel(HM)is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function.This study used HM to quantify the left ventricular end-diastolic(LVEDV)and end-systolic volumes(LVESV)of patients with dilated cardiomyopathy(DCM),coronary artery heart disease with segmental wall motion abnormality,and hypertrophic cardiomyopathy(HCM)to determine whether there were differences in the feasibility,accuracy,and repeatability of measuring the LVEDV,LVESV,LV ejection fraction(LVEF)and left atrial end-systolic volume(LAESV)and to compare these measurements with those obtained with traditional twodimensional(2D)and three-dimensional(3D)methods.AIM To evaluate the application value of HM in quantifying left heart chamber volume and LVEF in clinical patients.METHODS A total of 150 subjects who underwent 2D and 3D echocardiography were divided into 4 groups:(1)42 patients with normal heart shape and function(control group,Group A);(2)35 patients with DCM(Group B);(3)41 patients with LV remodeling after acute myocardial infarction(Group C);and(4)32 patients with HCM(Group D).The LVEDV,LVESV,LVEF and LAESV obtained by HM with(HM-RE)and without regional endocardial border editing(HM-NE)were compared with those measured by traditional 2D/3D echocardiographic methods to assess the correlation,consistency,and repeatability of all methods.RESULTS(1)The parameters measured by HM were significantly different among the groups(P<0.05 for all).Compared with Groups A,C,and D,Group B had higher LVEDV and LVESV(P<0.05 for all)and lower LVEF(P<0.05 for all);(2)HM-NE overestimated LVEDV,LVESV,and LAESV with wide biases and underestimated LVEF with a small bias;contour adjustment reduced the biases and limits of agreement(bias:LVEDV,28.17 mL,LVESV,14.92 mL,LAESV,8.18 mL,LVEF,-0.04%).The correlations between HM-RE and advanced cardiac 3D quantification(3DQA)(r_(s)=0.91-0.95,P<0.05 for all)were higher than those between HM-NE(r_(s)=0.85-0.93,P<0.05 for all)and the traditional 2D methods.The correlations between HM-RE and 3DQA were good for Groups A,B,and C but remained weak for Group D(LVEDV and LVESV,r_(s)=0.48-0.54,P<0.05 for all);and(3)The intraobserver and interobserver variability for the HM-RE measurements were low.CONCLUSION HM can be used to quantify the LV volume and LVEF in patients with common heart diseases and sufficient image quality.HM with contour editing is highly reproducible and accurate and may be recommended for clinical practice.
基金a grant (No.81270245 to T.L.) from the National Natural Science Foundation of China
文摘Background: Recent observational studies have suggested that the patients with hyperuricemia have a higher risk of having left atrial thrombus (LATH) or left atrial spontaneous echo contrast (LASEC) by transesophageal echocardiography (TEE), while the ultimate predictive value of a high uric acid (UA) level on LATH/LASEC remained obscure. Methods: We searched the PubMed and Cochrane clinical trials databases up to July 2015. Following screening the 369 initially identified studies, we analyzed six observational studies with 2381 patients. Results: The meta-analysis of these studies showed that an elevated serum UA level was associated with a higher likelihood of LATH/LASEC (OR ? 1.59, 95%CI 1.13e2.23, P ? 0.008), while significant differences exist among individual trials (P<0.00001 and I2 ? 85%). Sensitivity analysis failed to find any heterogeneity. Conclusion: An elevated UA level was associated with a higher risk of detecting a left atrial abnormality represented by LATH/LASEC.
文摘目的应用四维自动左房定量技术(4D Auto LAQ)评价不同透析方式对尿毒症患者左房结构和功能的影响。方法选取于我院肾内科就诊的尿毒症患者80例,根据透析方式分为血液透析组39例和腹膜透析组41例,另选同期健康体检者35例作为正常对照组。应用常规超声心动图获取左室射血分数(LVEF)、左房内径(LAD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW);4D Auto LAQ获取左房应变参数,包括左房储备期纵向应变(LASr)、左房管道期纵向应变(LAScd)、左房收缩期纵向应变(LASct)、左房储备期环形应变(LASr-c)、左房管道期环形应变(LAScd-c)、左房收缩期环形应变(LASct-c),以及左房容积参数,包括左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房收缩前容积(LAVpreA)、左房射血分数(LAEF),比较各组上述参数的差异;分析LAEF与左房应变参数的相关性。结果①各组常规超声心动图参数比较:腹膜透析组和血液透析组LAD、LVEDD、IVS、LVPW均较正常对照组增大,差异均有统计学意义(均P<0.05);各组LVEF比较差异无统计学意义。②各组4D Auto LAQ左房应变参数比较:与正常对照组比较,腹膜透析组LASr、LAScd、LASr-c、LAScd-c均减小,LASct、LASct-c均增大,血液透析组LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c均减小,差异均有统计学意义(均P<0.05);除LAScd外,血液透析组LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c均较腹膜透析组减小,差异均有统计学意义(均P<0.05)。③各组4D Auto LAQ左房容积参数比较:与正常对照组比较,腹膜透析组LAVmax、LAVmin、LAVpreA均增大,LAEF减小,血液透析组LAVmax、LAVmin、LAVpreA均增大,LAEF减小,差异均有统计学意义(均P<0.05);与腹膜透析组比较,血液透析组LAVmax、LAmin、LAVpreA均增大,LAEF减小,差异均有统计学意义(均P<0.05)。④相关性分析显示,LAEF与LASr、LAScd、LASr-c、LAScd-c、LASct、LASct-c均呈正相关(r=0.531、0.522、0.705、0.686、0.306、0.376,均P<0.001)。结论4D Auto LAQ可用于评价不同透析方式对尿毒症患者左房结构和功能的影响,其中血液透析较腹膜透析对左房结构和功能影响更大。
