实时三维超声心动图评价慢性心力衰竭患者左心房功能和同步性的初步研究  

Evaluation of the function and synchronization of left atrial in chronic heart failure patients by real-time three-dimensional echocardiography

作　　者：曹省[1] 郭瑞强[1] 陈金玲[1] 郝力丹[1] 何娟[1] 

机构地区：[1]武汉大学人民医院超声影像科,430060

出　　处：《中华超声影像学杂志》2012年第2期116-120,共5页Chinese Journal of Ultrasonography

摘　　要：目的 应用实时三维超声心动图（RT-3DE）定量评价左房功能及其同步性.方法 应用RT-3DE对30例健康受试者和32例慢性心力衰竭患者（其中左室充盈压正常者19例为CHF1组,升高者13例为CHF2组）进行左房容积-时间曲线分析,获取左房容积指标：最大容积（LAVmax）、最小容积（LAVmin）、收缩前容积（LAVp）,并计算左房总射血分数（LATEF）、被动射血分数（LAPEF）及主动射血分数（LAAEF）.同时获得左房同步性参数：左室16节段、12节段和6节段达最小容积时间标准差（Tmsv-16-SD、Tmsv-12-SD、Tmsv-6 SD）和最大时间差（Tmsv-16-Dif、Tmsv-12 Dif、Tmsv-6-Dif）.容积指标用体表面积进行标化,时间参数用R-R间期校正.分析校正后的同步性指标Tmsv-16-SD％、Tmsv-16-Dif％与容积指数LAVmaxI等的相关性.结果 ①各容积指标校正前后,对照组、CHF1组、CHF2组依次增大（P＜0.01）,LATEF、LAPEF和LAAEF依次减小（P＜0.01）.②同步性指标在三组间依次增大,差异有统计学意义（P ＜0.01）,但两两间比较显示,除Tmsv 16-SD％和Tmsv-16-Dif％外,其余指标在CHF1 组和CHF2组间差异无统计学意义（P＞0.05）.③Tmsv-16 SD％、Tmsv-16-Dif％与容积指数呈正相关,与射血分数呈负相关,其中与LAVmaxI相关性最强（r =0.75,P＜0.01）.结论 慢性心力衰竭患者左房功能减低,存在着不同步性.随着左室充盈压增高,不同步性更加显著.实时三维超声心动图可以较好地评价左房功能和同步性.Objective To evaluate the function and synchronization of left atrial in patients with chronic heart failure（CHF） by real-time three dimensional echocardiography （RT-3DE）.Methods Thirty healthy controls and thirty-two patients with CHF were studied.The CHF were divided into group CHF1 with the normal of left ventricular filling pressure and group CHF2 with the elevated of that.From the volume-time curve of RT-3DE workstation,the maximum volume （LAVmax）,the minimum volume （LAVmin）,the volume before contraction （LAVp） of left atrial were acquired.Accordingly,the total,passive and active ejection fraction could be calculated.The synchronization parameters derived from RT3DE were the dispersion and maximum difference of time to minimum volume for left atrial segments （Tmsv- 16-SD,Tmsv 12-SD,Tmsv-6-SD,Tmsv- 16-Dif,Tmsv 12-Dif,Tmsv-6 Dif）.The index of volume and time were corrected by the body surface area and interval of R-R,respectively.The correlation were analysed in them.Results ① All the index of volume before and after correction were gradually increasing from control to CHF2 group,but the LATEF,LAPEF and LAAEF were just the reverse,with all parameters had significant difference among total groups（ P 〈0.01 ）.②The synchronization parameters were significantly higher from control to CHF2 group（ P 〈0.01 ）.Comparing between two groups,no significant difference of the synchronization parameters were found between CHF1 group and CHF2 group （ P 〉 0.05）,except Tmsv-16-SD% and Tmsv-16-Dif% （ P 〈0.01 ）.③The Tmsv-16-SD% and Tmsv-16-Dif% had a positive correlation with the index of volume and a negative correlation with the ejection fraction.The most significantly correlation parameters was LAVmaxI,with r =0.75 and P 〈0.01.Conclusions The function of left atrium are reduced in patients of CHF,there are dyssynchronization.The higher of the filling pressure of left ventricle,the lager of the dyssynchronization of left atrium.RT-3DE may paly important roles in the evaluat

关 键 词：超声心动描记术 实时三维 心力衰竭 充血性 心房功能 左 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.6[医药卫生—诊断学]