基于超声四维左房定量分析技术评价原发性高血压左心室肥厚患者的左房功能  

Evaluation of left atrial function in essential hypertensive patients with left ventricular hypertrophy based on four-dimensional echocardiographic quantitative analysis

作　　者：洪俊蓉 张平洋[1] 王玲玲[1] 张建鑫[1] 任俊怡[1] 费梦瑶 万林林[1] HONG Junrong;ZHANG Pingyang;WANG Lingling;ZHANG Jianxin;REN Junyi;FEI Mengyao;WAN Linlin(Department of Cardiovascular Ultrasound,Nanjing First Hospital,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China;Department of Functional Examination,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心血管超声科,江苏南京210006 [2]南京中医药大学附属南京中医院(南京市中医院)功能检查科,江苏南京210006

出　　处：《分子影像学杂志》2022年第5期648-655,共8页Journal of Molecular Imaging

基　　金：江苏省卫健委医学科研重点项目(ZD2021048)。

摘　　要：目的基于超声四维左房定量分析(4DLAQ)技术评价原发性高血压(EH)左心室肥厚(LVH)患者的左房功能。方法选择EH患者80例,根据LVH的新标准将患者分为LVH组无LVH(NLVH)组,同时选取36例健康体检者作为对照组,3组均采用二维超声心动图测量得到二维超声数据,采用4DLAQ技术测量及分析得到左房容积参数包括左房最小容积(LAV_(min))、左房最大容积(LAV_(max))、左房收缩前容积(LAV_(preA))、左房整体射血分数(LAEF);左房应变参数包括左房储备期长轴应变、左房管道期长轴应变、左房收缩期长轴应变、左房储备期环形应变、左房管道期环形应变、左房收缩期环形应变,比较3组二维和四维技术所得数据的差异。结果3组收缩压及舒张压的差异有统计学意义(P<0.05)。3组左心房内径、双平面左室射血分数、室间隔厚度、左心室舒张末期内径、左心室后壁厚度、E/e’的差异均有统计学意义(P<0.05)。3组LAV_(min)、LAV_(preA)、LAEF、左心房被动射血分数、左心房主动射血分数的差异有统计学意义(P<0.05),而LVA_(max)的差异无统计学意义(P>0.05)。3组左房应变参数的差异均有统计学意义(P<0.05)。观察者间和观察者内的一致性较好(组内相关系数>0.90)。结论EH患者左房内径增大早于左室收缩功能受损,随着疾病进展左房容积升高,储存功能、管道功能受损,泵血功能处于NLVH时增加,随着LVH程度加重,左房泵血功能减低。4DLAQ能发现EH患者左房功能细微的改变,其应变参数评价左房功能更敏感,其中环形应变在表达左房管道功能上比纵向应变更具优势。Objective To evaluate left atrial function in essential hypertensive(EH) patients with left ventricular hypertrophy(LVH) based on four-dimensional echocardiographic quantitative(4DLAQ).Methods Eighty EH patients were selected and divided into NLVH group and LVH group according to the new LVH standard.At the same time,36 healthy subjects were selected as the control group.The participants in the three groups were measured by two-dimensional echocardiography,and the left atrial volume parameters were measured and analyzed by 4DLAQ technology,including left atrial minimum volume(LAV_(min)),left atrial maximum volume(LAV_(max)),left atrial pre systolic volume(LAV) and left atrial global ejection fraction(LAV_(preA)).The left atrial strain parameters include left atrial reserve long axial strain,left atrial conduit long axial strain,left atrial systolic long axial strain,left atrial reserve circular strain,left atrial conduit circular strain and left atrial systolic circular strain.The differences between the two-dimensional and four-dimensional data of the three groups of participants were compared.Results There were significant differences in mean systolic blood pressure and mean diastolic blood pressure among the three groups(P<0.05).There were significant differences in left atrial diameter,Biplane LVEF,interventricular septal thickness,left ventricular end-diastolic diameter,left ventricular posterior wall thickness and E/e’ among the three groups(P<0.05).There was significant difference in LAV_(min),LAV_(preA),LAEF,left atrial passive ejection fraction and left atrial active ejection fraction among the three groups(P<0.05),but there was no significant difference in LAV_(max)(P>0.05).There were significant differences in left atrial strain parameters among the three groups(P<0.05).The consistency between and within observers was good(ICC>0.90).Conclusion The increase of left atrial diameter in EH patients is earlier than the impairment of left ventricular systolic function.With the progress of the disease,the l

关 键 词：四维左房定量分析 原发性高血压 左心房功能 左心室肥厚 左房应变 左房容积 

分 类 号：R445.1[医药卫生—影像医学与核医学] R544.11[医药卫生—诊断学]