实时三维斑点追踪成像技术评价老年缺血性二尖瓣反流患者左心房功能的研究  

Assessment of left atrial function in elderly patients with ischemic mitral regurgitation by real-time three-dimensional speckle tracking imaging

作　　者：姜婧璇 姜志荣[1] 王小凡[1] 吕启凤[1] 宋晓霞[1] 田雨[1] Jiang Jingxuan;Jiang Zhirong;Wang Xiaofan;Lyu Qifeng;Song Xiaoxia;Tian Yu(Department of Cardiac Ultrasound,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院心脏超声科,266000

出　　处：《中华老年医学杂志》2020年第1期27-32,共6页Chinese Journal of Geriatrics

摘　　要：目的应用实时三维斑点追踪成像(RT3D-STI)技术检测老年缺血性二尖瓣反流患者的左心房心肌运动及容积变化,评价左心房功能。方法选取86例老年慢性冠心病患者,根据有无继发于冠状动脉病变的二尖瓣反流分为单纯冠心病(CHD)组(32例)及缺血性二尖瓣反流(IMR)组(54例,其中20例轻度反流、18例中度反流、16例重度反流),对照组为32例老年健康志愿者。应用RT3D-STI技术测量左心房心肌整体纵向、圆周、径向应变及左心房最大容积、最小容积、主动收缩前容积,并计算左心房总体(LAEF)、被动(LApEF)及主动射血分数(LAaEF),分析左心房容积变化及心肌应变与左心房功能的关系。结果CHD组与IMR组左心室射血分数(LVEF)、LAEF均较对照组降低,且IMR组低于CHD组;与对照组比较,IMR组左心房最小容积(LAVmin)增大、LAaEF降低(均P<0.05)。IMR组及CHD组左心房整体纵向应变(GLS)、左心房整体圆周应变(GCS)、左心房整体径向应变(GRS)与对照组比较均降低,且IMR组低于CHD组,随反流程度增加,GLS、GCS、GRS均不同程度减低;与对照组比较,IMR组左心房整体纵向应变达峰时间标准差(TLS-SD)、左心房整体圆周应变达峰时间标准差(TCS-SD)、左心房整体径向应变达峰时间标准差(TRS-SD)均增大(均P<0.05)。CHD组及IMR组GLS、GCS、GRS与LAEF呈较强相关性(CHD组r=-0.745、-0.718、0.627,P=0.006、0.007、0.009;IMR组r=-0.785、-0.781、0.643,P=0.006、0.007、0.008)。TLS-SD、TCS-SD、TRS-SD评价左心房功能改变的ROC曲线分析结果显示,曲线下面积分别为0.903、0.890、0.872,其灵敏度与特异度分别为89.7%、81.8%,78.6%、84.8%,85.7%、72.1%。结论通过测量IMR患者左心房容积变化及追踪描记心肌运动,RT3D-STI技术可较准确、客观地评价老年IMR患者左心房功能的改变。Objective To assess left atrial(LA)function by evaluating changes of LA wall movement and volume detected by real-time three-dimensional speckle tracking imaging(RT3D-STI)in elderly patients with ischemic mitral regurgitation(IMR).Methods Eighty-six elderly patients with coronary heart disease(CHD)were enrolled in this study.According to whether or not to have IMR,the patients were divided into the pure CHD group(n=32)and the CHD-induced ischemic mitral regurgitation(IMR)group(n=54,including 20 cases of mild IMR,18 cases of moderate IMR and 16 cases of severe IMR).Thirty-two healthy elderly volunteers were considered as control group.RT3D-STI was used to evaluate the global atrial longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS)and LA maximal,minimal and pre-systolic volumes(LAVmax,LAVmin,and LAVp).LA ejection fraction(LAEF),LA passive ejection fraction(LApEF)and LA active ejection fraction(LAaEF)were calculated.The relationship of LA volume changes and myocardial strain with LA function was analyzed.Results The left ventricular ejection fraction(LVEF)and LAEF were reduced in CHD group and IMR group as compared with the control group,and were lower in IMR group than in CHD group(P<0.05).Compared with the control group,the LAVmin was increased,and the LAaEF was decreased in the IMR group(P<0.05).Compared with the control group,the GLS,GCS,GRS were declined in the CHD and IMR groups,and were lower in IMR group than in control group(P<0.05).Along with the increased severity of regurgitation,GLS,GCS,and GRS were decreased in varying degrees.The standard deviations of time to peak longitudinal strains(TLS-SD),of time to peak circumferential strains(TCS-SD),and of time to peak radial strain(TRS-SD)rose in the IMR group as compared with the control group(P<0.05).The myocardial motion indicators(GLS,GCS,GRS)had a quite strong correlation with LAEF in the CHD and IMR groups(CHD group:r=-0.745,-0.718 and 0.627,P=0.006,0.007 and 0.009;IMR group:r=-0.785,-0.781,0.643,P=0.006,0.007 and 0.0

关 键 词：冠心病 二尖瓣闭锁不全 超声心动描记术 三维 心房功能 左 

分 类 号：R541[医药卫生—心血管疾病] R542[医药卫生—内科学]