CAJ | 학술논문

目的应用三维斑点追踪技术(3D-STE)和实时三维超声心动图(RT3DE)评估探讨左室射血分数保留心衰(HFpEF)患者左房功能变化及意义.方法将43例HFpEF患者根据左房大小分为A组(左房最大容积指数LAVImax＜ 34 mL/m2)和B组(LAVImax≥34 ml/m2),18例健康者为对照组.应用3 DSTE分析获取左房基底(Basal)、中间(Middle)、房顶(Roof)和整体(Global)的心室收缩期长轴峰值应变(LSs％)与心房收缩前长轴峰值应变(LSa％),结合RT3 DE和多普勒超声参数进行比较分析.结果左房中部应变参数具满意可重复性(ICC ＞0.8),A组左房充盈和排空期形变功能减低以中部为主[与对照组相比:MLSs(33 ±6)％与(45±9)％,MLSa(12±3)％与(17±5)％;P＜0.05],B组基底和房顶部形变功能也明显降低[与A组和对照组相比:BLSs(18 ±7)％与(25±8)％与(29±8)％,RLSs (24±9)％与(28±8)％与(32±10)％;与对照组相比:BLSa(11±5)％与(14士4)％,RLSa(12±5)％与(15±5)％;P＜0.05].HFpEF患者左房僵硬度明显增加,左房充盈扩张分数(LAEI％)和被动射血分数(LAPEF％)明显降低,B组左房主动射血分数(LAAEF％)也显著降低.结论 3D-STE结合RT3DE可有效评估HFpEF左房功能.左房中部应变参数是评估左房功能的理想指标.HFpEF患者左房储备、通道和泵功能均明显降低,存在明显舒张功能不全,这些变化在左房明显增大患者中更为显著.
목적 응용삼유반점추종기술(3D-STE)화실시삼유초성심동도(RT3DE)평고탐토좌실사혈분수보류심쇠(HFpEF)환자좌방공능변화급의의.방법 장43례HFpEF환자근거좌방대소분위A조(좌방최대용적지수LAVImax＜ 34 mL/m2)화B조(LAVImax≥34 ml/m2),18례건강자위대조조.응용3 DSTE분석획취좌방기저(Basal)、중간(Middle)、방정(Roof)화정체(Global)적심실수축기장축봉치응변(LSs％)여심방수축전장축봉치응변(LSa％),결합RT3 DE화다보륵초성삼수진행비교분석.결과 좌방중부응변삼수구만의가중복성(ICC ＞0.8),A조좌방충영화배공기형변공능감저이중부위주[여대조조상비:MLSs(33 ±6)％여(45±9)％,MLSa(12±3)％여(17±5)％;P＜0.05],B조기저화방정부형변공능야명현강저[여A조화대조조상비:BLSs(18 ±7)％여(25±8)％여(29±8)％,RLSs (24±9)％여(28±8)％여(32±10)％;여대조조상비:BLSa(11±5)％여(14사4)％,RLSa(12±5)％여(15±5)％;P＜0.05].HFpEF환자좌방강경도명현증가,좌방충영확장분수(LAEI％)화피동사혈분수(LAPEF％)명현강저,B조좌방주동사혈분수(LAAEF％)야현저강저.결론 3D-STE결합RT3DE가유효평고HFpEF좌방공능.좌방중부응변삼수시평고좌방공능적이상지표.HFpEF환자좌방저비、통도화빙공능균명현강저,존재명현서장공능불전,저사변화재좌방명현증대환자중경위현저.
Objective To evaluate left atrial function changes inheart failure with preserved ejection fraction (HFpEF) patients by three-dimensional speckle-tracking echocardiography (3D-STE) and Real time three-dimensional echocardiograph(RT3DE).Methods 43 HFpEF patients and a control group with 18 healthy subjectswere enrolled.According to left atrial max volume index (LAVImax),patients were grouped as A (LAVImax ＜ 34 ml/m2) and B (LAVImax≥34 ml/m2).3D-STE deformative parameters,left atrial ventricular-systolic longitudinal peak strain (LSs％)and left atrial pre-contraction longitudinal peak strain (LSa％),from three levels (Basal,Middle and Roof) and global were measured.These parameters combined with RT3DE and Doppler parameters were analyzed between groups.Results Reproducibilities of MLSs and MLSa were satisfactory (ICC ＞ 0.8).In group A,LA filling and emptying deformation reduced mainly in middle level (compared to control group:MLSs (33 ± 6) ％ vs (45 ± 9) ％,MLSa (12 ± 3) ％ vs (17 ±5)％,P ＜0.05),while in group B,deformation of basal and roof levels also reduced (compared to A and control group:BLSs (18 ±7)％ vs (25 ±8)％ vs (29 ±8)％,RLSs (24 ±9)％ vs (28 ±8)％ vs (32 ±10)％;compared to control group:BLSa (11 ±5)％ vs (14 ±4)％,RLSa (12 ±5)％ vs (15 ±5)％;all P＜ 0.05).LA stiffness increased while LA expansion index (LAEI％),LA passive ejection fraction (LAPEF％) decreased significantly in HFpEF patients,LA active ejection fraction (LAAEF％) of group B also decreased.Conclusions 3D-STE in combination with RT3DE enables the assessment of LA function effectively and comprehensively.3D-STE strains of LA middle level were ideal parameters for LA function assessment.HFpEF patients have significantly reduced LA reservoir,conduit,pump function and left ventricular diastolic dysfunction,and these changes were more apparent in patients with LA enlarged significantly.