| 摘要: |
| 目的 探讨四维自动左心房定量(4D AUTO LAQ)技术评价原发性高血压(EH)患者左心房重塑的临床应用价值。方法 收集2020年9月至2021年9月就诊于我院的EH患者99例,根据左心室质量指数(LVMI)将病例组分为非左心室壁肥厚(NLVH)组(n=53),左心室壁肥厚(LVH)组(n=46)；血压正常健康体检者48例作为对照组(n=48)。常规及组织多普勒超声检查获取左心房内径(LADs)、左心室质量(LVM)、左心室射血分数(LVEF)、二尖瓣口舒张早期流速(E)、二尖瓣口舒张晚期流速(A)、二尖瓣环舒张早期运动速度峰值(e")、E/e"等参数；4D AUTO LAQ技术检查获取左心房的容积和应变参数,包括左心房最小容积(LAVmin)、左心房收缩前容积(LAVpreA)、左心房最大容积(LAVmax)、左心房容积指数(LAVI)、左心房储器期纵向应变(LASr)、左心房储器期圆周应变(LASr-c)、左心房导管期纵向应变(LAScd)、左心房导管期圆周应变(LAScd-c)、左心房增压泵期纵向应变(LASct)、左心房增压泵期圆周应变(LASct-c)等,比较三组各参数差异；绘制受试者工作特征(ROC)曲线计算4D AUTO LAQ技术各参数的曲线下面积。结果 常规超声结果显示：与对照组相比,NLVH组LADs、LVEF差异无统计学意义(P>0.05)；与对照组相比,LVH组LADs增大,LVEF降低(P<0.05)；与NLVH组相比,LVH组LADs增大(P<0.05),LVEF差异无统计学意义(P>0.05)。4D AUTO LAQ技术结果显示：与对照组相比,NLVH组LASr、LAScd降低,差异有统计学意义(P<0.05),LAEF差异无统计学意义(P>0.05)；LVH组LASr、LASr-c、LASct、LASct-c、LAScd、LAEF降低,差异有统计学意义(P<0.05)；LVH组LASr、LASr-c、LASct、LASct-c、LAEF低于NLVH组,差异有统计学意义(P<0.05)。ROC曲线分析显示LASr评价EH患者左心房功能比其它左心房应变参数更敏感(对照组和NLVH组比较,曲线下面积为0.813；对照组和LVH组比较,曲线下面积为0.918；NLVH组和LVH组比较,曲线下面积为0.790)。结论 EH患者左心房应变改变早于左心室收缩功能改变。左心房应变参数中,LASr、LAScd评估EH患者左心房功能的效能最高。4D AUTO LAQ技术可用于高血压患者早期左心房容积及应变参数的获取,从而对左心房功能进行评估。 |
| 关键词: 四维自动左心房定量技术 原发性高血压 左心房功能 左心室功能 |
| DOI： |
| 投稿时间：2022-04-16修订日期：2022-04-16 |
| 基金项目:国家自然科学(No.81971626),黑龙江省重点研发计划项目(No.GA21D007) |
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| Assessment of left atrial function in essential hypertension patients using four-dimensional automated left atrial quantification technique |
| XU Mingyuan,OU Yanmei,LI Piyu,LENG Xiaoping |
| (Department of Ultrasound Medicine,The Second Affiliated Hospital of Harbin Medical University) |
| Abstract: |
| Objective The objective of this study was to investigate the clinical application of 4D AUTO LAQ technology in evaluating left atrial functions in patients with Essential hypertension (EH). Methods Ninety-nine EH patients treated in our hospital from September 2020 to September 2021 were enrolled. According to the diagnostic criteria of left ventricular mass index (LVMI), the case group was divided into non-left ventricular hypertrophy (NLVH) group (n=53) and left ventricular hypertrophy (LVH) group (n=46). Healthy physical examiners were enrolled as the control group (n=48). Conventional echocardiography parameters including left atrial systole diameter (LADs), left ventricular mass (LVM), left ventricular ejection fraction (LVEF), early diastolic transmitral inflow velocity (E), late diastolic transmitral inflow velocity (A), peak velocity of the transmitral annulus early diastole（e''）, E/e'', etc; 4D AUTO LAQ technique was used to measure the volume and strain parameters of left atrial, including left atrial minimum volume (LAVmin), left atrial volume before A wave (LAVpreA), left atrial maximum volume (LAVmax), left atrial maximum volume index (LAVI), left atrial reservoir phase longitudinal strain (LASr), left atrial reservoir phase circumferential strain (LASr-c), left atrial ductal phase longitudinal strain (LAScd), left atrial ductal phase circumferential strain (LAScd-c), left atrial systolic phase longitudinal strain (LASct) and left atrial systolic phase circumferential strain (LASct-c). The differences of conventional ultrasound parameters and 4D AUTO LAQ technical parameters among the three groups were compared. Draw the ROC curve and calculate the area under the curve of each 4D AUTO LAQ technical parameter. Results The conventional echocardiography showed that there was no significant difference in LADs and LVEF between NLVH group and control group (P>0.05). Compared with the control group, LVEF decreased and LADs increased in LVH group (P<0.05); LADs of the LVH group was higher than that in NLVH group (P<0.05), and the difference in the LVEF group was not statistically significant (P>0.05). The 4D AUTO LAQ technical parameters showed that compared with the control group, LASr and LAScd were decreased in NLVH group(P<0.05), and there was no significant difference in LAEF (P>0.05); LASr, LAScd, LASct, LASr-c, LASct-c and LAEF decreased in LVH group (P<0.05). Compared with NLVH group, LASr, LASct, LASr-c, LASct-c and LAEF decreased in LVH group (P<0.05). ROC curve analysis showed that LASr was more sensitive to evaluate left atrial function than other left atrial strain parameters in patients with EH(Comparison between control group and NLVH group, AUC was 0.813; Comparison between control group and LVH group, AUC was 0.918; Comparison between NLVH group and LVH group, AUC was 0.790). Conclusion Changes in left atrial strain in patients with EH occur before left ventricular systolic function. Among the left atrial strain parameters, LASr and LAScd are the most effective in evaluating left atrial function in patients with EH. 4D AUTO LAQ technology can be used to obtain the early left atrial volume and strain parameters in hypertensive patients to assess left atrial function. |
| Key words: Four-dimensional automated left atrial quantification technique essential hypertension left atrial function left ventricular function |
