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目的运用实时三维超声心动图(RT-3DE)技术定量评价慢性心力衰竭患者左心房容积和功能,并对其不同步性作初步研究。方法选择30例健康受试者和32例慢性心力衰竭患者,分为对照组和心力衰竭组。心力衰竭组:男性18例,女性14例;年龄42~65岁,平均年龄58岁。对照组:男性17例,女性13例;年龄45~60岁,平均年龄54岁。用RT-3DE进行左心房时间-容积曲线分析,获取容积指标:最大容积(LAVmax)、最小容积(LAVmin)、主动收缩前容积(LAVp),计算左心房总射血分数(LATEF)、被动射血分数(LAPEF)及主动射血分数(LAAEF)。同时获得左心房不同步性参数:达最小容积时间标准差Tmsv-16-SD、Tmsv-12-SD、Tmsv-6-SD和最大时间差Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif。容积指标用体表面积进行标化,时间参数用R-R间期校正。并分析校正后的不同步性指标Tmsv-16-SD%、Tmsv-16-Dif%与容积指数LAVmaxI等的相关性。结果①各容积指标校正前后,心力衰竭患者左心房容积均增大,左心房射血分数LATEF、LAPEF和LAAEF均减小,差异有显著统计学意义(P<0.01)。②不同步性指标Tmsv-16-SD%、Tmsv-16-Dif%等在心力衰竭组增大,差异均有显著统计学意义(P<0.01)。③Tmsv-16-SD%、Tmsv-16-Dif%与各容积指数呈正相关关系,与各射血分数呈负相关关系,其中与LAVmaxI相关性最强,r分别为0.73、0.75(均为P<0.01)。结论慢性心力衰竭患者左心房功能减低,存在着不同步性。RT-3DE可以较好地评价左心房功能和不同步性。
Objective To quantitatively evaluate the volume and function of left atrium in patients with chronic heart failure by real-time three-dimensional echocardiography (RT-3DE) and to make a preliminary study of its asynchronous. Methods Thirty healthy subjects and 32 patients with chronic heart failure were selected and divided into control group and heart failure group. Heart failure group: 18 males and 14 females; aged 42 to 65 years, mean age 58 years. Control group: 17 males and 13 females; aged 45 to 60 years, mean age 54 years. Left ventricular time-volume curve analysis was performed by RT-3DE to obtain volumetric indexes of LAVmax, LAVmin, LAVp, left atrial total ejection fraction (LATEF), passive irradiation Blood fraction (LAPEF) and active ejection fraction (LAAEF). At the same time, the left atrial non-synchrony parameters were obtained: standard deviation Tmsv-16-SD, Tmsv-12-SD, Tmsv-6-SD and maximum time difference Tmsv-16-Dif, Tmsv-12-Dif, Tmsv-6 -Dif. Volume indicators with the body surface area of the standardization, time parameters with R-R interval correction. The correlations between Tmsv-16-SD%, Tmsv-16-Dif% and volume index LAVmaxI were also analyzed. Results ① Before and after the calibration of each volume index, the volume of left atrium in patients with heart failure increased, and the left atrial ejection fraction LATEF, LAPEF and LAAEF decreased. The difference was statistically significant (P <0.01). ② Asynchrony index Tmsv-16-SD%, Tmsv-16-Dif% increased in heart failure group, the difference was statistically significant (P <0.01). (3) There was a positive correlation between Tmsv-16-SD% and Tmsv-16-Dif% with each volume index and a negative correlation with each ejection fraction, of which the correlation was the strongest with LAVmaxI (r = 0.73,0.75, P < 0.01). Conclusion Left atrial function is reduced in patients with chronic heart failure, there is an asynchronous. RT-3DE can better assess left atrial function and asynchronous.