超声心动图估测急性二尖瓣反流合并左心室舒张功能障碍犬左心房压的准确性  

Echocardiographic estimation of left atrial pressure in dogs with acute mitral regurgitation and left ventricular diastolic dysfunction

作　　者：郑海宁 金岩 付煜玮 张佳琦 王辉山 温朝阳 ZHENG Haining;JIN Yan;FU Yuwei;ZHANG Jiaqi;WANG Huishan;WEN Chaoyang(Graduate School of the Chinese PLA Medical College,Beijing 100853,China;Department of Ultrasound,Peking University International Hospital,Beijing 102206,China;Department of Cardiology,General Hospital of the Northern Theater Command,Shenyang 110016,China;Department of Ultrasound,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]解放军医学院研究生院,北京100853 [2]北京大学国际医院超声科,北京102206 [3]中国人民解放军北部战区总医院心外科,沈阳110016 [4]中国医学科学院阜外医院超声科,北京100037

出　　处：《中国医科大学学报》2020年第11期964-968,972,共6页Journal of China Medical University

基　　金：国家自然科学基金(81771833);北京市自然科学基金(7172209)。

摘　　要：目的评估超声心动图估测急性二尖瓣反流(MR)、MR合并左心室舒张功能障碍(LVDD)犬左心房压(LAP)的能力。方法选择8只健康成年比格犬,经导管活检钳夹断腱索制作急性MR模型(MR组),然后通过导管将塑料微球悬液缓慢注入冠状动脉窦造成LVDD,制作急性MR合并LVDD模型(MR+LVDD组)。每个模型制作成功后,分别间隔60 min先后2次采集二尖瓣口脉冲多普勒频谱、二尖瓣环组织多普勒频谱,每个模型共16个测量点,用Nagueh公式计算左心房压(LAPECHO),LAPECHO=(1.24×[E/e’]+1.9)。采用导管法测量同一心动周期的左心房压(LAPC)。结果MR组和MR+LVDD组平均LAPC分别为(13.33±1.78)和(18.77±0.92)mmHg,2组比较差异有统计学意义(P<0.001),E/e’分别为(10.73±2.14)和(10.44±1.27)mmHg,2组比较差异无统计学意义(P=0.555)。MR组LAPECHO与LAPC呈线性正相关(r=0.881,P<0.001),MR+LVDD组LAPECHO与LAPC呈线性负相关(r=-0.897,P<0.001)。分析测得的MR组与MR+LVDD组全部32组数据,LAPECHO与LAPC无线性相关性(r=0.131,P=0.473);排除MR+LVDD组中E/A>1的10组数据,剩余22组数据中LAPECHO与LAPC则呈正相关(r=0.731,P<0.001)。结论超声心动图可以估测急性MR比格犬LAP,对于急性MR合并LVDD的比格犬,超声心动图估测LAP的能力仍有待进一步验证。Objective To evaluate the ability of echocardiography to estimate left atrial pressure(LAP)in beagle dogs with acute mitral regurgitation(MR)and MR combined with left ventricular diastolic dysfunction(LVDD).Methods Eight healthy adult dogs were selected to establish an acute MR model(MR group)and MR combined with LVDD model(MR+LVDD group).After the successful establishment of the two dog models,the pulsed Doppler spectrum of mitral blood flow and the tissue Doppler spectrum of mitral annulus were collected twice at an interval of 60 min,and the LAP curve(LAPC)was recorded synchronously.The LAPECHO was calculated using the Nagueh formula(LAPECHO=1.24×[E/e’]+1.9).There were 16 measurement points for each model.Results The LAPC of the MR and MR+LVDD group was 13.33±1.78 mmHg and 18.77±0.92 mmHg,respectively,which was significantly different(P<0.001).E/e’was 10.73±2.14 and 10.44±1.27,respectively,without a statistically significant difference(P=0.555).There was a linear positive correlation between LAPECHO and LAPC in the MR group(r=0.881,P<0.001),and a negative correlation between LAPECHO and LAPC in the MR+LVDD group(r=-0.897,P<0.001).By analyzing all 32 measurements from the MR and MR+LVDD groups,there was no linear correlation between LAPECHO and LAPC(r=0.131,P=0.473).After excluding 10 measurements of E/A>1 from the MR+LVDD group,LAPECHO was still positively correlated with LAPC in the remaining 22 measurements with E/A<1(r=0.731,P<0.001).Conclusion Echocardiography is able to estimate LAP in dogs with acute MR.For dogs with acute MR combined with LVDD,the ability of echocardiography to estimate LAP remains to be further verified.

关 键 词：左心室舒张功能障碍 左心房压 组织多普勒 二尖瓣反流 

分 类 号：R445.1[医药卫生—影像医学与核医学]