CAJ | 학술논문

目的应用实时三维超声心动图(RT-3DE)定量评价左房功能及其同步性.方法应用RT-3DE对30例健康受试者和32例慢性心力衰竭患者(其中左室充盈压正常者19例为CHF1组,升高者13例为CHF2组)进行左房容积-时间曲线分析,获取左房容积指标:最大容积(LAVmax)、最小容积(LAVmin)、收缩前容积(LAVp),并计算左房总射血分数(LATEF)、被动射血分数(LAPEF)及主动射血分数(LAAEF).同时获得左房同步性参数:左室16节段、12节段和6节段达最小容积时间标准差(Tmsv-16-SD、Tmsv-12-SD、Tmsv-6 SD)和最大时间差(Tmsv-16-Dif、Tmsv-12 Dif、Tmsv-6-Dif).容积指标用体表面积进行标化,时间参数用R-R间期校正.分析校正后的同步性指标Tmsv-16-SD％、Tmsv-16-Dif％与容积指数LAVmaxI等的相关性.结果 ①各容积指标校正前后,对照组、CHF1组、CHF2组依次增大(P＜0.01),LATEF、LAPEF和LAAEF依次减小(P＜0.01).②同步性指标在三组间依次增大,差异有统计学意义(P ＜0.01),但两两间比较显示,除Tmsv 16-SD％和Tmsv-16-Dif％外,其余指标在CHF1 组和CHF2组间差异无统计学意义(P＞0.05).③Tmsv-16 SD％、Tmsv-16-Dif％与容积指数呈正相关,与射血分数呈负相关,其中与LAVmaxI相关性最强(r =0.75,P＜0.01).结论慢性心力衰竭患者左房功能减低,存在着不同步性.随着左室充盈压增高,不同步性更加显著.实时三维超声心动图可以较好地评价左房功能和同步性.
목적 응용실시삼유초성심동도(RT-3DE)정량평개좌방공능급기동보성.방법 응용RT-3DE대30례건강수시자화32례만성심력쇠갈환자(기중좌실충영압정상자19례위CHF1조,승고자13례위CHF2조)진행좌방용적-시간곡선분석,획취좌방용적지표:최대용적(LAVmax)、최소용적(LAVmin)、수축전용적(LAVp),병계산좌방총사혈분수(LATEF)、피동사혈분수(LAPEF)급주동사혈분수(LAAEF).동시획득좌방동보성삼수:좌실16절단、12절단화6절단체최소용적시간표준차(Tmsv-16-SD、Tmsv-12-SD、Tmsv-6 SD)화최대시간차(Tmsv-16-Dif、Tmsv-12 Dif、Tmsv-6-Dif).용적지표용체표면적진행표화,시간삼수용R-R간기교정.분석교정후적동보성지표Tmsv-16-SD％、Tmsv-16-Dif％여용적지수LAVmaxI등적상관성.결과 ①각용적지표교정전후,대조조、CHF1조、CHF2조의차증대(P＜0.01),LATEF、LAPEF화LAAEF의차감소(P＜0.01).②동보성지표재삼조간의차증대,차이유통계학의의(P ＜0.01),단량량간비교현시,제Tmsv 16-SD％화Tmsv-16-Dif％외,기여지표재CHF1 조화CHF2조간차이무통계학의의(P＞0.05).③Tmsv-16 SD％、Tmsv-16-Dif％여용적지수정정상관,여사혈분수정부상관,기중여LAVmaxI상관성최강(r =0.75,P＜0.01).결론 만성심력쇠갈환자좌방공능감저,존재착불동보성.수착좌실충영압증고,불동보성경가현저.실시삼유초성심동도가이교호지평개좌방공능화동보성.
Objective To evaluate the function and synchronization of left atrial in patients with chronic heart failure(CHF) by real-time three dimensional echocardiography (RT-3DE).Methods Thirty healthy controls and thirty-two patients with CHF were studied.The CHF were divided into group CHF1 with the normal of left ventricular filling pressure and group CHF2 with the elevated of that.From the volume-time curve of RT-3DE workstation,the maximum volume (LAVmax),the minimum volume (LAVmin),the volume before contraction (LAVp) of left atrial were acquired.Accordingly,the total,passive and active ejection fraction could be calculated.The synchronization parameters derived from RT3DE were the dispersion and maximum difference of time to minimum volume for left atrial segments (Tmsv- 16-SD,Tmsv 12-SD,Tmsv-6-SD,Tmsv- 16-Dif,Tmsv 12-Dif,Tmsv-6 Dif).The index of volume and time were corrected by the body surface area and interval of R-R,respectively.The correlation were analysed in them.Results ① All the index of volume before and after correction were gradually increasing from control to CHF2 group,but the LATEF,LAPEF and LAAEF were just the reverse,with all parameters had significant difference among total groups( P ＜0.01 ).②The synchronization parameters were significantly higher from control to CHF2 group( P ＜0.01 ).Comparing between two groups,no significant difference of the synchronization parameters were found between CHF1 group and CHF2 group ( P ＞ 0.05),except Tmsv-16-SD％ and Tmsv-16-Dif％ ( P ＜0.01 ).③The Tmsv-16-SD％ and Tmsv-16-Dif％ had a positive correlation with the index of volume and a negative correlation with the ejection fraction.The most significantly correlation parameters was LAVmaxI,with r =0.75 and P ＜0.01.Conclusions The function of left atrium are reduced in patients of CHF,there are dyssynchronization.The higher of the filling pressure of left ventricle,the lager of the dyssynchronization of left atrium.RT-3DE may paly important roles in the evaluation of function and synchronization of left atrium.