基于二维斑点追踪超声心动图测定的左心房功能与HFpEF-ABA评分在高血压患者中的相关性研究  

Correlation between left atrial function based on two-dimensional speckle tracking echocardiography and the HFpEF-ABA score in hypertensive patients

作　　者：马佳琪 刘轩昌 金冬霞 耿婕 Ma Jiaqi;Liu Xuanchang;Jin Dongxia;Geng Jie(Clinical School of Thoracic,Tianjin Medical University,Tianjin 300070,China;Department of Cardiology,Chest Hospital,Tianjin University,Tianjin 300051,China;Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care,Tianjin Municipal Science and Technology Bureau,Tianjin 300051,China)

机构地区：[1]天津医科大学胸科临床学院,300070 [2]天津大学胸科医院心血管内科,300051 [3]天津市心血管急危重症重点实验室、天津市科学技术局,300051

出　　处：《中国心血管杂志》2025年第2期123-130,共8页Chinese Journal of Cardiovascular Medicine

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-055B);天津市科技计划项目(22JCZDJC00580)。

摘　　要：目的探讨在高血压患者中二维斑点追踪超声心动图(2D-STE)测定的左心房功能与HFpEF-ABA评分的相关性。方法单中心、横断面研究。连续纳入2022年9月至2023年12月就诊于天津大学胸科医院心血管内科的207例高血压患者平均年龄(59.2±14.6)岁,男性107例(48.3%)。收集患者临床资料,超声心动图检查测定左心房直径、左心房容积、左心室舒张末期内径、舒张末期室间隔厚度、左心室后壁厚度及肺动脉收缩压等参数,计算左心室质量指数及左心房容积指数,脉冲多普勒成像技术测定二尖瓣舒张早期血流速度峰值(E)和二尖瓣舒张晚期血流速度峰值(A)。组织多普勒成像技术测定间隔侧和侧壁侧二尖瓣环舒张早期运动速度(间隔侧e′和侧壁侧e′)。利用2D-STE测定左心房储蓄功能(LASr)、导管功能(LAScd)和收缩功能(LASct)。采用H_(2)FPEF和HFpEF-ABA评分对高血压患者HFpEF风险进行评估,根据HFpEF-ABA评分将患者分为:低概率组(40例)、中概率组(131例)和高概率组(36例)。通过计算Kappa值进行H_(2)FPEF和HFpEF-ABA评分工具的一致性分析。采用受试者工作特征曲线评估LASr、LAScd和LASct在HFpEF-ABA评分体系下对疑似射血分数保留的心力衰竭(HFpEF)的预测价值。通过Spearman相关性分析探讨LASr、LAScd和LASct与HFpEF-ABA评分的相关性。使用单因素和多因素线性回归分析不同变量与HFpEF-ABA评分的相关性。结果在HFpEF-ABA评分系统中,3组间年龄,性别,心率,糖尿病、冠心病、心房颤动和脑卒中患者比例,以及B型利钠肽、左心房直径、左心房容积指数、A、E、E/A、间隔侧e′、侧壁侧e′、E/e′和肺动脉收缩压比较,差异均有统计学意义(均为P<0.05)。左心房功能学参数LASr、LAScd、LASct均随着HFpEF风险的增加而降低,且与HFpEF-ABA评分呈负相关(均为P<0.001)。HFpEF-ABA与H_(2)FPEF评分在高血压人群中对HFpEF风险评估具有一致性(Kappa=0.537Objective To investigate the correlation between left atrial function assessed by two-dimensional speckle tracking echocardiography(2D-STE)and the HFpEF-ABA score in hypertensive patients.Methods A single-center cross-sectional study was conducted.A total of 207 hypertensive patients who visited the Department of Cardiology,Chest Hospital,Tianjin University between September 2022 and December 2023 were consecutively enrolled.The average age was 59.2±14.6 years old,and there were 107 males(48.3%).Clinical data and echocardiographic parameters were collected,including left atrial diameter,left atrial volume,left ventricular end-diastolic diameter,interventricular septal thickness,left ventricular posterior wall thickness and pulmonary arterial systolic pressure.Left ventricular mass index and left atrial volume index were calculated.Pulsed-wave Doppler was used to measure the peak early diastolic(E wave)and the peak late diastolic(A wave)mitral inflow velocity.Tissue Doppler imaging was employed to measure the peak early diastolic mitral annular velocities(e′)at the septal and lateral walls.Left atrial function was evaluated using 2D-STE to determine left atrial reservoir strain(LASr),conduit strain(LAScd),and contractile strain(LASct).The H_(2)FPEF and HFpEF-ABA scores were used to retrospectively assess the risk of heart failure with preserved ejection fraction(HFpEF)in hypertensive patients.Based on the HFpEF-ABA score,patients were categorized into 3 groups:low probability(40 cases),intermediate probability(131 cases),and high probability(36 cases).Agreement between the H_(2)FPEF and HFpEF-ABA scoring tools was evaluated by calculating the Kappa value.The diagnostic value of LASr,LAScd,and LASct for suspected HFpEF under the HFpEF-ABA scoring system was assessed using receiver operating characteristic curve analysis.Spearman correlation analysis was performed to explore the correlations between LASr,LAScd,LASct and the HFpEF-ABA score.Univariate and multivariate linear regression analyses were conducted to e

关 键 词：高血压 射血分数保留的心力衰竭 左心房功能 二维斑点追踪超声心动图 HFpEF-ABA评分 

分 类 号：R544.1[医药卫生—心血管疾病]