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目的应用二维斑点追踪应变显像技术(2DSTE)及三维超声心动图(3DE)分析肥厚型心肌病(HCM)患者左心房容积变化及心房肌应变率的特点。方法 46例HCM患者(梗阻性HCM组25例,非梗阻性HCM组21例)与46名健康对照者(健康对照组)入选此研究。应用2DSTE检测入选者左心室收缩期左心房峰值应变率(SRs)、左心室舒张早期左心房峰值应变率(SRe)、左心室舒张晚期(心房收缩期)左心房峰值应变率(SRa)。应用3DE获得入选者左心房最大容积(LAVmax)、左心房最小容积(LAVmin)及左心房收缩前容积(LAVp),计算左心房容积指数(LAVI)、左心房扩张指数(LAEI)、左心房被动排空分数(LAPEF)及左心房主动排空分数(LAAEF)。组间比较采用独立样本t检验,心房肌应变率与左心房容积变化的关系采用Pearson线性相关分析。结果与健康对照组LAVI(25.63±6.52)、LAEI(1.32±0.49)%、LAPEF(36.40±7.03)%、LAAEF(29.79±9.31)%、SRs(2.94±1.01)、SRe(-2.79±1.29)、SRa(-2.55±1.03)比较,HCM组LAVI(45.39±14.17)明显增大,2组间差异有统计学意义(t=8.436,P<0.01);LAEI(0.95±0.43)%、LAPEF(25.32±9.18)%、SRs(2.17±0.55)、SRe(-1.17±0.43)均明显减低,2组间差异亦有统计学意义(t=-3.865、-6.504、-4.543、8.091,P均<0.01);LAAEF(28.20±9.26)%、SRa(-2.22±0.77)仅轻度减低,两组间差异无统计学意义(t=-0.656、1.744,P均>0.01);HCM组患者,SRs、SRe、SRa的绝对值与LAVI呈轻至中度负相关(r=-0.406,-0.328,-0.368,p=0.006,0.03,0.014)。SRs与LAEI无显著相关性(r=0.276,p=0.063),SRe的绝对值与LAPEF、SRa的绝对值与LAAEF呈中度正相关(r=0.434,0.400,p<0.01)。结论 3DE和2DSTE均能够有效评价左心房功能。HCM患者表现为左心房容积增大,各时相容积变化分数及应变率减低。梗阻性与非梗阻性HCM患者间各参数间的差异并不显著。心房肌各时相应变率与左心房容积及相关时相的容积变化分数间仅呈轻至中等程度的相关性。
Objective To analyze the changes of left atrium volume and the rate of atrial fibrillation in patients with hypertrophic cardiomyopathy (HCM) by two-dimensional speckle tracking strain imaging (2DSTE) and three-dimensional echocardiography (3DE) Methods 46 cases of HCM patients (25 cases of obstructive HCM, 21 cases of non-obstructive HCM) and 46 healthy controls (healthy control group) were enrolled in this study. The left atrial peak strain rate (SRs), left atrial peak strain rate (SRe) and left atrial peak strain rate (SRa) in the late stage of left ventricular diastole (atrial systole) were detected by 2DSTE. The left atrium volume index (LAVI), left atrial expansion index (LAEI), left atrium passive index (LVEF) and left atrial appendage volume (LVEF) were calculated by 3DE to obtain the left ventricular maximum volume (LAVmax), left ventricular minimum volume (LAVmin) Emptying fraction (LAPEF) and left atrial active emptying fraction (LAAEF). Group comparison using independent samples t-test, atrial muscle strain rate and left atrial volume changes using Pearson linear correlation analysis. Results Compared with healthy control group, LAVI (LAVI), LAEI (1.32 ± 0.49)%, LAPEF (36.40 ± 7.03)%, LAAEF (29.79 ± 9.31)%, SRs (2.94 ± 1.01), SRe (-2.79 ± 1.29) (0.45 ± 0.43)%, LAPEF (0.95 ± 0.43)%, P <0.01), and LAVF in the HCM group was significantly higher than that in the HCM group (P <0.01) 25.32 ± 9.18)%, SRs (2.17 ± 0.55) and SRe (-1.17 ± 0.43), respectively. There was also a significant difference between the two groups (t = -3.865, -6.504, -4.543, 0.01). LAAEF (28.20 ± 9.26)% and SRa (-2.22 ± 0.77) were only mildly decreased, with no significant difference between the two groups (t = -0.656,1.744, P all> 0.01) The absolute values of SRe and SRa were negatively correlated with LAVI (r = -0.406, -0.328, -0.368, p = 0.006,0.03,0.014). There was no significant correlation between SRs and LAEI (r = 0.276, p = 0.063). The absolute values of SRe, LAPEF and SRa were moderately correlated with LAAEF (r = 0.434, 0.400, p <0.01). Conclusion Both 3DE and 2DSTE can effectively evaluate left atrial function. HCM patients showed atrial enlargement of the left atrium, changes in volume fraction of each phase and strain rate decreased. The differences between the parameters of obstructive and non-obstructive HCM patients were not significant. Atrial fibrillation at each time corresponding rate and left atrial volume and related time phase volume change score was only mild to moderate correlation.