| 摘要: |
| 目的 应用四维超声心动图（4DE）的左房定量技术评估冠心病（CHD）患者左房容积及应变的改变情况。方法 选取我院临床疑诊为CHD且二维超声心动图（2DE）未发现节段性室壁运动异常（RWMA）的住院患者62例，根据冠状动脉造影（CAG）结果分为CHD组41例和对照组21例，均于CAG术前行2DE获取左房前后径（LAD）、左室射血分数（LVEF）、二尖瓣口舒张早期峰值血流速度（E）与二尖瓣环舒张早期峰值位移速度（e）之比（E/e）, 4DE获取左房最小容积（LAVmin）、左房最大容积（LAVmax）、左房最小容积指数（LAVImin）、左房最大容积指数（LAVImax）、左房收缩期前容积（LAVApre）、左房射血容积（LAEV）、左房射血分数（LAEF），左房储备、管道、辅泵期纵向应变（LASr、LAScd、LASct）及环向应变（LASr_c、LAScd_c、LASct_c）；比较两组一般资料和各超声心动图参数的差异。绘制受试者工作特征曲线（receiver operating characteristic，ROC）评价4DE参数对CHD的诊断价值。根据CAG结果进一步将CHD组分为LCX累及组和非LCX累及组，比较两组各超声心动图参数的差异。采用组内相关系数（ICC）检验各超声心动图参数的重复性。结果 CHD组与对照组一般资料和各2DE参数比较，差异均无统计学意义；与对照组比较，CHD组LAVmin、LAVImin均增大，LAEF、LASr、LASr_c、LAScd_c、LASct_c均减小，差异均有统计学意义（均P＜0.05）。ROC曲线分析显示，LASr_c以＜33.5%为截断值，诊断CHD的灵敏度为90.2%，特异度为71.4%，曲线下面积为0.891。LCX累及组与非LCX累及组各超声心动图参数比较，差异均无统计学意义。重复性检验显示，各2DE和4DE参数在观察者内和观察者间的重复性良好（ICC均＞0.640）。结论 应用4DE左房定量技术可准确评估CHD患者左房容积和应变改变情况，其中LASr_c对CHD患者的诊断效能最佳，有一定的临床价值。 |
| 关键词: 超声心动描记术，三维，实时 左房定量技术 左房应变，左房环向应变 冠心病 |
| DOI： |
| 投稿时间：2022-09-01修订日期：2023-05-29 |
| 基金项目:载基因新型超声分子探针靶向抑制血管再狭窄及其与VSMC自噬关系的研究 |
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| Four-dimensional Quantification on Left Atrial Volume-Strain in Coronary Heart Disease Patients |
| Fei Mengyao,Zhang Pingyang,Li Miao,Dong Jing,Sheng Zongxiang,Yao Yujuan |
| (Department of Cardiovascular Ultrasound,Nanjing First Hospital,Nanjing Medical University) |
| Abstract: |
| Objective To explore the changes of left atrial (LA) volume and function in coronary heart disease (CHD) patients by four-dimensional (4D) LA quantification. Methods 62 patients ，who were clinically suspected of CHD and without regional wall motion abnormalities (RWMA) under two-dimensional echocardiography (2DE) at rest were enrolled. 41 patients diagnosed with CHD by CAG were categorized as CHD group while 21 patients with negative CAG results served as the control group. LA end-systolic anteroposterior diameter (LAD)，left ventricular ejection fraction (LVEF)，the ratio of early diastolic peak transmitral flow velocities (E) and peak mitral annular displacement velocities (a) (E/e) were acquired by 2DE. LA minimum volume (LAVmin)，LA maximum volume (LAVmax)，LA volume at the onset of atrial contraction (LAVpreA)，LAVmin index (LAVImin), LAVmax index (LAVImax), LA ejection volume (LAEV), LA ejection fraction (LAEF), LA longitudinal and circumferential strain during reservoir (LASr， LASr_c)， conduit (LAScd, LAScd_c) and contraction phase (LASct，LASct_c) were obtained by 4DE. Then we compared the baseline information and echocardiographic parameters between these two groups. And the receiver operating characteristic curve (ROC) was conducted to evaluate the diagnostic value of 4DE parameters for CHD. The CHD group was furtherly divided into LCX involved and non-LCX involved groups based on CAG results，and then left atrial parameters by 2DE and 4DE between these two groups were compared. The interclass correlation coefficients (ICC) were used to test the reproducibility of echocardiographic parameters. Results There were no significant differences in baseline demographics and 2DE parameters between the CHD and control group，and all P＞0.05. LAVmin，LAVminI were increased and LAEF，LASr，LASr_c，LAScd_c，LASct_c were decreased significantly in the CHD group when compared with those in the control group，and all P＜0.05. LASr_c demonstrates the highest area under the ROC curve ((AUC=0.891，P=0.000) sensitivity 90.2%，specificity 71.4%), with the cut-off value of 33.5% for predicting CHD patients. There were no significant differences in left atrial echocardiographic parameters between LCX involved and non-LCX involved groups. All echocardiographic parameters documented showed good reproducibility (ICC＞0.640). Conclusions 4D LA quantification can effectively evaluate the changes of LA volume and function. LASr_c showed the best diagnostic capacity for CHD patients, which provides a new method for clinical research on CHD. |
| Key words: Echocardiography, Three-dimensional, real-time, LA quantification, LA strain, LA circumferential strain, CHD |
