CAJ | 학술논문

目的应用实时三维超声心动图(RT-3DE)评估左心室不同舒张功能状态的冠心病患者左心房容积与功能并探讨三维测量的左心房参数与左心室舒张功能分级的关系.方法 80例冠心病患者根据左心室不同舒张功能状态分成舒张功能正常组、松弛功能降低组、假性正常化组及限制性充盈障碍组,各20例.比较4组左心房最大容积(LAVmax)、左心房收缩前容积(LAVpre)、左心房最小容积(LAVmin),体表面积校正后得出LAVmax指数、LAVpre指数、LAVmin指数,计算左心房总排空分数(LAVtEF)、左心房被动排空分数(LAVpEF)、左心房主动排空分数(LAVaEF).结果在左心室舒张功能异常各组中,二尖瓣频谱的二尖瓣血流舒张早期速度峰值E/心房收缩期速度峰值(A)、E/二尖瓣环舒张早期峰值速度(Em)、E/左心室舒张早期血流传播速度(Vp)随着舒张功能障碍加重而增加,而E峰减速时间(DT)随着舒张功能障碍加重而降低(均P＜0.05)；LAVmax、LAVpre、LAVmin、LAVmax指数、LAVpre指数、LAVmin指数随舒张功能降低而增加,LAVtEF随舒张功能降低而降低(P＜0.05)；E/Em、E/Vp、DT与RT-3DE测量LAVmax指数、LAVpre指数、LVAmin指数、LAVtEF显著相关(r=0.75、0.70、0.73、-0.79；r =0.75、0.68、0.72、-0.83；r=-0.70、-0.69、-0.67、0.74,均P＜0.05).LAVmax指数≥34 ml/m2,LAVtEF≤30％诊断左心室充盈压增高(即E/Em＞ 15),其敏感度和特异度分别为85.7％、65.6％及85.1％、81.6％.结论 RT-3DE测量左心房容积与功能各项参数有助于临床更准确地评价左心室舒张功能.
목적 응용실시삼유초성심동도(RT-3DE)평고좌심실불동서장공능상태적관심병환자좌심방용적여공능병탐토삼유측량적좌심방삼수여좌심실서장공능분급적관계.방법 80례관심병환자근거좌심실불동서장공능상태분성서장공능정상조、송이공능강저조、가성정상화조급한제성충영장애조,각20례.비교4조좌심방최대용적(LAVmax)、좌심방수축전용적(LAVpre)、좌심방최소용적(LAVmin),체표면적교정후득출LAVmax지수、LAVpre지수、LAVmin지수,계산좌심방총배공분수(LAVtEF)、좌심방피동배공분수(LAVpEF)、좌심방주동배공분수(LAVaEF).결과 재좌심실서장공능이상각조중,이첨판빈보적이첨판혈류서장조기속도봉치E/심방수축기속도봉치(A)、E/이첨판배서장조기봉치속도(Em)、E/좌심실서장조기혈류전파속도(Vp)수착서장공능장애가중이증가,이E봉감속시간(DT)수착서장공능장애가중이강저(균P＜0.05)；LAVmax、LAVpre、LAVmin、LAVmax지수、LAVpre지수、LAVmin지수수서장공능강저이증가,LAVtEF수서장공능강저이강저(P＜0.05)；E/Em、E/Vp、DT여RT-3DE측량LAVmax지수、LAVpre지수、LVAmin지수、LAVtEF현저상관(r=0.75、0.70、0.73、-0.79；r =0.75、0.68、0.72、-0.83；r=-0.70、-0.69、-0.67、0.74,균P＜0.05).LAVmax지수≥34 ml/m2,LAVtEF≤30％진단좌심실충영압증고(즉E/Em＞ 15),기민감도화특이도분별위85.7％、65.6％급85.1％、81.6％.결론 RT-3DE측량좌심방용적여공능각항삼수유조우림상경준학지평개좌심실서장공능.
Objective To evaluate left atrial (LA) function and LA volumetric parameters in patients with coronary artery diseases (CAD) by real-time three-dimensional echocardiography (RT-3DE).And to assess the relationship between left ventricular(LV) diastolic function and LA parameters by RT-3DE.Methods Eighty patients with CAD were divided into four groups:the normal,the impaired relaxation,the pseudonormal and the rest rictive filling groups.All patients underwent three dimensional echocardiography to measure the LA maximum volume,LA volume pre contraction,left atrial minimum volume and the indices of LAVmax,LAVpre and LAVmin adjusted by surface area.Then LAVtEF,LAVpEF,LAVaEF were calculated.The peak flow velocities during early diastole (E),atrial contraction (A),E/A ratio were recorded and calculated by two-dimensional echocardiography (2DE).The early peak of diastolic velocity of mitral annular velocity(Em),drag acceleration time of E and the early left ventricular diastole propagation velocity(Vp) were measured by tissue Doppler imaging.The results by 2DE and RT-3DE of all patients were respectively compared.Results There were increasing in E/A,E/Em,and E/Vp and decreasing in DT with increasing in the grading of the LV diastolic function (all P ＜ 0.05).There were increasing in LAVmax,LAVpre,LAVmin,LAVmax index,LAVpre index,LAVmin index and decreasing in LAVtEF with increasing in the grading of the LV diastolic function(P ＜ 0.05).The E/Em,E/Vp,DT well correlated to LAVmax index,LAVpre index,LVAmin index,LAVtEF by RT-3 DE,r was 0.75,0.70,0.73,-0.79,respectively (all P ＜ 0.05) and 0.75,0.68,0.72,-0.83,respectively (all P ＜ 0.05) and-0.70,-0.69,-0.67,0.74,respectively (all P ＜0.05).LAVmax index≥34 ml/m2,LAVtEF≤30％ could diagnose high left rentricular filling pressure (E/Em ＞ 15),the sensitivity and specificity were 85.7％,65.6％ and 85.1％,81.6％ respectively.Conclusion The indices of LA volume and function by RT-3DE in patients with CAD may have great value for assessing the left ventricular diastolic function.