三维超声心动图评估心尖肥厚型心肌病患者左心房结构与功能的临床研究  

Evaluation of left atrial structure and function by three-dimensional echocardiography in paitents with apical hypertrophic cardiomyopathy

作　　者：郑康超 周玮[1] 朱英 张隽[1] 田洁 包雨微 陆永萍 邓又斌[1] 刘娅妮 Zheng Kangchao;Zhou Wei;Zhu Ying;Zhang Jun;Tian Jie;Bao Yuwei;Lu Yongping;Deng Youbin;Liu Yani(Department of Ultrasound Imaging,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Ultrasound,the Affliated Hospital of Yunnan University,Kunming 650021,China)

机构地区：[1]华中科技大学同济医学院附属同济医院超声影像科,武汉430030 [2]云南大学附属医院超声科,昆明650021

出　　处：《中华超声影像学杂志》2023年第11期985-994,共10页Chinese Journal of Ultrasonography

基　　金：湖北省自然科学基金(2021CFB336);云南省心血管超声创新团队(202305AS350021)

摘　　要：目的:探讨三维超声心动图评估心尖肥厚型心肌病(ApHCM)患者左心房结构与功能的临床价值。方法:连续性纳入2020年9月至2022年12月于华中科技大学同济医学院附属同济医院确诊的112例ApHCM患者作为ApHCM组,根据肥厚心肌累及的范围(仅累及心尖段或心尖段与中间段)分为单纯型与混合型ApHCM。41例年龄、性别相匹配的健康志愿者作为对照组。采集受检者二维及三维超声心动图图像,比较对照组与ApHCM组、单纯型和混合型ApHCM患者左心房二维及三维容积与应变参数的差异。分析左心房二维及三维参数的相关性和可重复性,绘制ROC曲线建立左心房容积异常三维容积参数截断值。应用Logistics回归分析确定ApHCM患者左心房扩大的影响因素。结果:与对照组相比较,ApHCM组二维左心房最大容积指数(2D LAVimax)、二维左心房最小容积指数(2D LAVimin)、三维左心房最大容积指数(3D LAVimax)、三维左心房最小容积指数(3D LAVimin)、三维左心房收缩前期容积指数(3D LAVipreA)增大( Z=-6.54、-6.38、-6.98、-7.40、-6.96,均 P<0.001),而二维左心房射血分数(2D LAEF)( Z=-3.75, P<0.001)、二维左心房扩张指数(2D LAEI)( t=-4.15, P<0.001)、三维左心房射血分数(3D LAEF)( Z=-5.09, P<0.001)、三维左心房扩张指数(3D LAEI)( t=-5.49, P<0.001)、二维左心房存储期应变(2D LASr)( t=-12.03, P<0.001)、二维左心房管道期应变(2D LAScd)( t=7.91, P<0.001)、二维左心房收缩期应变(2D LASct)( t=6.06, P<0.001)、三维左心房存储期应变(3D LASr)( t=-9.23, P<0.001)、三维左心房管道期应变(3D LAScd)( t=7.12, P<0.001)、三维左心房收缩期应变(3D LASct)( t=4.78, P<0.001)均减小,差异有统计学意义。ApHCM患者中,混合型的2D LAVimax、3D LAVimax、2D LAVimin、3D LAVimin、3D LAVipreA较单纯型显著增大(均 P<0.05),2D LAEF、2D LAEI、2D LASr显著减少(均 P<0.05);而3D LAEI、3D LASr在两种类型间差异无统计学意义(均 P>ObjectiveTo investigate the changes of left atrial structure and function in patients with apical hypertrophic cardiomyopathy(ApHCM)by three-dimensional(3D)echocardiography.MethodsFrom September 2020 to December 2022,112 patients with ApHCM(ApHCM group)diagnosed at Tongji Hospital Tongji Medical College,Huazhong University of Science and Technology and 41 age-and sex-matched normal controls(control group)were finally enrolled.In'pure’ApHCM patients,cardiac hypertrophy was confined to the apical segment below the papillary muscle.The wall thickness of apical and intermediate segments in'mixed’ApHCM patients increased,but the wall thickness of apical segment was the largest.Two-dimensional(2D)and 3D volume and strain parameters of left atrium were compared between control group and ApHCM group,'pure’and'mixed’ApHCM patients.The correlations between 2D and 3D volume and strain parameters of left atrium and intraclass correlation coefficient(ICC)of those parameters were analyzed.The ROC curve was performed to determine the cutoff values of 3D left atrial volume abnormalities in all subjects.Logistics regression analysis was performed to analyze the impact factors of the left atrial enlargement in patients with ApHCM.ResultsCompared with the control group,2D left atrial maximum volume index(2D LAVimax),2D left atrial minimum volume index(2D LAVimin),3D left atrial maximum volume index(3D LAVimax),3D left atrial minimum volume index(3D LAVimin),and 3D left atrial presystolic volume index(3D LAVipreA)significantly increased in ApHCM group(Z=-6.54,-6.38,-6.98,-7.40,-6.96;all P<0.001).However,2D left atrial ejection fraction(2D LAEF)(Z=-3.75,P<0.001),2D left atrial expansion index(2D LAEI)(t=-4.15,P<0.001),3D left atrial ejection fraction(3D LAEF)(Z=-5.09,P<0.001),3D left atrial expansion index(3D LAEI)(t=-5.49,P<0.001),2D left atrial reservoir strain(2D LASr)(t=-12.03,P<0.001),2D left atrial conduit strain(2D LAScd)(t=7.91,P<0.001),2D left atrial contractile strain(2D LASct)(t=6.06,P<0.001),3D left atrial reservo

关 键 词：超声心动描记术 三维 心尖肥厚型心肌病 左心房 

分 类 号：R540.45[医药卫生—心血管疾病] R542.2[医药卫生—内科学]