论文部分内容阅读
摘要:目的 探討二维斑点追踪技术(STI)所测容积及应变参数在评估急性心肌梗死(AMI)患者左心房功能中的作用。方法 选择泰州市人民医院2020年1月至2020年7月的部分患者行超声检查并计算其左房容积指数(LAVI),将32例AMI患者作为A组,34例心功能正常者作为B组,观察上述患者左心房容积及应变参数与患者心脏功能的相关性。结果 与B组比较,A组患者左房内径(LAd)、左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房收缩期前容积(LAVp)、LAVI均明显升高, 左房被动排血分数(LAPEF)、左房主动排血分数(LAAEF)、左房总排血分数(LATEF)、左室射血分数(LVEF)、左房收缩期峰值应变率(SRs)、左房舒张早期峰值应变率(SRe)、左房舒张晚期峰值应变率(SRa)、左房整体纵向变形(GLAS)均显著降低,差异有统计学意义(P<0.05)。患者LAVI与年龄、SRa呈正相关(r=0.380,0.539 ,P<0.05),与SRs、GLAS呈负相关(r=-0.413,-0.516 ,P<0.05),与SRe相关性不显著(r=0.231 ,P>0.05)。结论 STI能检测出AMI患者左房功能的改变,测得的LAVI、SRs、SRa、GLAS等参数能很好地评价患者左房功能。
关键词:急性心肌梗死;斑点追踪技术;左心房;应变
【中图分类号】R541 【文献标识码】A 【文章编号】1673-9026(2020)06-001-03
Evaluation of Left Atrial Function in Patients with Acute Myocardial Infarction by Speckle Tracking Technique
Chai Wenwen1,2,Yang Guirong1,Chen Gecai1,Wang Zhongyang1
1.Taizhou People's Hospital,Taizhou 225300,China
2.Graduate School of Dalian Medical University,Dalian 116000,China
Abstract:Objective Objective to investigate the role of left atrial volume and strain parameters measured by two-dimensional speckle tracking (STI) in evaluating left atrial function in patients with acute myocardial infarction (AMI).Methods From January 2020 to July 2020,part of patients in Taizhou People's hospital were examined by echocardiography and their left atrial volume index (LAVI) was calculated. 32 patients with AMI were selected as group A and 34 patients with normal cardiac function were selected as group B. the correlation between left atrial volume and strain parameters and cardiac function was observed. Results Compared with group B,left atrial diameter (LAd),left atrial maximum volume (LAVmax),left atrial minimum volume (LAVmin),left atrial pre systolic volume (LAVp),left atrial passive ejection fraction (LAPEF),left atrial active ejection fraction (LAAEF),left atrial total ejection fraction (LATEF),left ventricular ejection fraction (LVEF),left atrial ejection fraction (LATEF) were significantly increased in group A The peak systolic strain rate (SRs), left atrial early diastolic peak strain rate (SRe),left atrial late diastolic peak strain rate (SRa) and left atrial global longitudinal deformation (GLAS) were significantly decreased (P < 0.05). LAVI in group A was significantly higher than that in group B,and the LAVI was positively correlated with age and SRa (r = 0.380, 0.539, P < 0.05),and negatively correlated with SRs and GLAS (r = -0.413,-0.516,P < 0.05),but not with SRe (r = 0.231,P > 0.05).Conclusion STI can accurately detect the changes of left atrial function in patients with AMI, and the measured parameters such as LAVI,SRs,SRa,GLAS can well evaluate the left atrial function of patients. Key Words: Acute myocardial infarction;Speckle tracking technology;Left atrium;Strain
左室在代偿状态下AMI患者的左房功能已减退[1-2]。LVEF已被广泛认为是心肌梗死后预后的主要预测指标,但AMI患者左房功能的减退往往早于其左室射血分數的改变 [3],这使得对AMI患者左房功能的研究显得更为重要。本研究应用STI测量左房容积、应变等指标来反映患者左房功能及其与患者LAVI的相关性。
1资料与方法
1.1 一般资料
研究对象是2020年1月至2020年7月在我院行超声检查的部分患者,时限为患者入院7天内,测算其心脏超声参数。将AMI患者32例及心功能正常者(无高血压、糖尿病、心脏相关疾病)34例分组为A、B组。A组中男21例,女11例,年龄(64.19±10.32)岁,体重(65. 08±10.27)kg,身高(165.16±8.01)cm;B组中男16例,女18例,年龄(61.18±8.26)岁,体重(60.41±9.17)kg,身高(163.88±7.54)cm。A组AMI的诊断经心肌酶、心电图及冠状动脉造影等确诊,排除已有心房颤动、中度以上瓣膜病、心肌病、阻塞性或限制性肺病的受试者。
1.2 方法
采用PHILIPS EPIQ7C型心脏超声诊断仪,X5-1 探头,被检者均接上胸导联心电图,取左侧卧位,在患者平稳呼吸期间应用常规二维超声记录三个连续的心动周期,留取其心尖四腔心及两腔心动态图像。最后应用Echo Pac软件脱机分析,应用斑点追踪技术分别在四腔心及两腔心切面上手动描绘左房、左室内膜曲线,系统自动勾划感兴趣区,若追踪不满意则可手动调节,系统自动得出相应各节段的应变曲线。在相应图像上测量并计算出平均LAd、LAVmax、LAVmin、LAVp、LVEF、SRs、SRe、SRa。处理数据得出LAVI及左房射血分数相关的数值。
1.3 统计学处理
采用SPSS 26.0软件进行统计学分析,计量资料采用() 表示,均数比较采用独立样本t检验,相关性检验采用Pearson相关分析。P<0.05为差异有统计学意义。
2结果
2. 1 患者超声参数的比较
A组患者LAd、LAVmax、LAVmin、LAVp、LAVI水平显著高于B组(P<0.05),LAPEF、LAAEF、LATEF、LVEF、SRs、SRe、SRa及GLAS水平显著低于B组(P<0.05)。见表1。
2.2 LAVI与年龄、应变力的相关性分析
LAVI与年龄、SRa分别存在正相关关系(r=0.380,0.539 ,P<0.05),与SRs、GLAS分别存在负相关关系(r=-0.413,-0.516 ,P<0.05),与SRe相关性不明显(r=0.231 ,P>0.05)。见表2。
3讨论
AMI患者的心肌僵硬度会不断增加,使左室充盈压逐渐升高,左房长期代偿性增加做功刺激左房重构,降低了左房射血的能力[4]。左房扩张能缩短左房不应期,增高心律失常发生的风险,左房室壁的牵拉扩张也使其对神经激素的分泌增加,这均促进心脏不良事件出现 [5]。左房容积及应变的改变能反映AMI患者的左房扩张、左室充盈压升高及左室舒张功能恶化[6-9]。Hsiao、Cameli等[10-11] 认为左房容积、应变力分别能预测AMI患者预后及左室舒张压升高。
本研究结果中,A组患者LAd、LAVmax、LAVmin、LAVp、LAVI水平显著高于B组(P<0.05), LAPEF、LAAEF、LATEF、LVEF水平明显低于B组(P<0.05),提示A组患者左房容积明显增大,左房舒张及射血功能明显减弱,表明A组患者左房重构及功能减退更严重。SRs、SRe及SRa水平分别反映左房的储存器、管道及辅助泵功能[12-13]。A组患者SRs、SRe、SRa及GLAS水平明显低于B组 ( P < 0. 05),表明左房扩张重构使AMI患者左房的储蓄、管道、辅助泵功能严重受损甚至失代偿。有研究表明[6],左房扩张及左室充盈量减低,会促进AMI患者出现心脏不良事件,这使得对左房功能的研究显得更有价值。本研究中患者LAVI与年龄、SRa呈正相关(r=0.380,0.539 ,P<0.05),与SRs、GLAS呈负相关(r=-0.413,-0.516 ,P<0.05),与SRe相关性不显著(r=0.231 ,P>0.05)。这表明随着患者年龄的增大其左房收缩功能会降低,且左房容积的增大会伴随其收缩应变功能的减退,左房容积与应变参数之间有较好的相关性。
4结论
本研究发现AMI患者左房功能显著减退,其年龄、SRa、SRs、GLAS等超声参数与LAVI有很强的相关性。STI受测量角度、混响、旁瓣和脱落伪影的影响较小[14],能相对精准地检测出心肌功能的变化,可更准确地评估AMI患者的左房功能。
参考文献
[1]成志远. 三维超声心动图在急性心肌梗死患者左心房功能评估中的应用分析[J].中西医结合心血管病杂志,2016,4(16):25-26.
[2]周洁莹,王建华,张敏郁,丁桂春,刘欣.实时三维超声心动图左心房容积成像评价高血压患者左心室舒张功能[J].中国医学影像技术,2009,25(11):2140-2141.
[3] Almeida Ana G. The Importance of Left Atrial Function for Prognosis after Acute Myocardial Infarction.[J]. Radiology,2019,293(2). [4] 邹文,杨彦青,邹满花,等.左心房容积指数在预测急性非ST段抬高型心肌梗死预后中的价值[J].实用临床医学,2016,17(9):49-52.
[5]Jacob E. M?ller,Graham S. Hillis,Patricia A.
Pellikka,James B. Seward,Guy S. Reeder,R. Scott Wright,Seung W. Park,Jae K. Oh. Left atrial volume: A powerful predictor of survival after acute myocardial infarction[J]. Journal of the American College of Cardiology,2003,41(6).
[6]朱佳,楊性安,王刚,林仙方.二维斑点追踪超声心动图评价急性心肌梗死患者左心房应变功能[J].心脑血管病防治,2015,15(02):131-132.
[7]Rine Bakkestr?m,Mads J. Andersen,Mads Ersb?ll,John Bro-Jeppesen,Finn Gustafsson,Lars K?ber,Christian Hassager,Jacob E. M?ller. Early changes in left atrial volume after acute myocardial infarction. Relation to invasive hemodynamics at rest and during exercise[J]. International Journal of Cardiology,2016,223.
[8]C.P. Appleton,J.M. Galloway,M.S. Gonzalez,M. Gaballa, M.A. Basnight,Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction,J. Am. Coll. Cardiol. 22 (1993) 1972–1982.
[9] M.A.Basnight,M.S. Gonzalez,S.C. Kershenovich,C.P. Appleton, Pulmonary venous flow velocity: relation to hemodynamics,mitral flow velocity and left atrial volume,and ejection fraction,J. Am. Soc. Echocardiogr. 4 (1991) 547–558.
[10]Hsiao Shih-Hung,Chu Kuo-An,Wu Chieh-Jen,Chiou Kuan-Rau. Left Atrial Expansion Index Predicts Left Ventricular Filling Pressure and Adverse Events in Acute Heart Failure With Severe Left Ventricular Dysfunction.[J]. Journal of cardiac failure,2016,22(4).
[11]Matteo Cameli,Matteo Lisi,Sergio Mondillo,Margherita Padeletti,Piercarlo Ballo,Charilaos Tsioulpas,Sonia Bernazzali,Massimo Maccherini. Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure[J]. ,2010,8(1).
[12]贾静静,董平栓.急性心肌梗死对左心房的影响[J].心血管病学进展,2014,35(06):685-688.
[13]Rafal Dabrowski,Anna Borowiec,Edyta Smolis-Bak,Ilona Kowalik,Cezary Sosnowski,Alicja Kraska,Barbara Kazimierska,Jacek Wozniak,Wojciech Zareba,Hanna Szwed. Effect of Combined Spironolactone–β-Blocker ± Enalapril Treatment on Occurrence of Symptomatic Atrial Fibrillation Episodes in Patients With a History of Paroxysmal Atrial Fibrillation (SPIR-AF Study)[J]. The American Journal of Cardiology,2010,106(11).
[14] Chunlai Shao,Jing Zhu,Jianchang Chen,Weiting Xu. Independent prognostic value of left atrial function by two-dimensional speckle tracking imaging in patients with non -ST-segment-elevation acute myocardial infarction[J]. ,2015,15(1).
作者简介:
(1)第一作者:柴文文,女,汉,1994年1月生,湖省随州人,研究生在读,研究方向:影像医学与核医学心脏超声方向。
(2)通讯作者:陈各才,男,汉,1979年12月生,江苏泰州人,硕士,研究方向:心血管疾病治疗及介入治疗
关键词:急性心肌梗死;斑点追踪技术;左心房;应变
【中图分类号】R541 【文献标识码】A 【文章编号】1673-9026(2020)06-001-03
Evaluation of Left Atrial Function in Patients with Acute Myocardial Infarction by Speckle Tracking Technique
Chai Wenwen1,2,Yang Guirong1,Chen Gecai1,Wang Zhongyang1
1.Taizhou People's Hospital,Taizhou 225300,China
2.Graduate School of Dalian Medical University,Dalian 116000,China
Abstract:Objective Objective to investigate the role of left atrial volume and strain parameters measured by two-dimensional speckle tracking (STI) in evaluating left atrial function in patients with acute myocardial infarction (AMI).Methods From January 2020 to July 2020,part of patients in Taizhou People's hospital were examined by echocardiography and their left atrial volume index (LAVI) was calculated. 32 patients with AMI were selected as group A and 34 patients with normal cardiac function were selected as group B. the correlation between left atrial volume and strain parameters and cardiac function was observed. Results Compared with group B,left atrial diameter (LAd),left atrial maximum volume (LAVmax),left atrial minimum volume (LAVmin),left atrial pre systolic volume (LAVp),left atrial passive ejection fraction (LAPEF),left atrial active ejection fraction (LAAEF),left atrial total ejection fraction (LATEF),left ventricular ejection fraction (LVEF),left atrial ejection fraction (LATEF) were significantly increased in group A The peak systolic strain rate (SRs), left atrial early diastolic peak strain rate (SRe),left atrial late diastolic peak strain rate (SRa) and left atrial global longitudinal deformation (GLAS) were significantly decreased (P < 0.05). LAVI in group A was significantly higher than that in group B,and the LAVI was positively correlated with age and SRa (r = 0.380, 0.539, P < 0.05),and negatively correlated with SRs and GLAS (r = -0.413,-0.516,P < 0.05),but not with SRe (r = 0.231,P > 0.05).Conclusion STI can accurately detect the changes of left atrial function in patients with AMI, and the measured parameters such as LAVI,SRs,SRa,GLAS can well evaluate the left atrial function of patients. Key Words: Acute myocardial infarction;Speckle tracking technology;Left atrium;Strain
左室在代偿状态下AMI患者的左房功能已减退[1-2]。LVEF已被广泛认为是心肌梗死后预后的主要预测指标,但AMI患者左房功能的减退往往早于其左室射血分數的改变 [3],这使得对AMI患者左房功能的研究显得更为重要。本研究应用STI测量左房容积、应变等指标来反映患者左房功能及其与患者LAVI的相关性。
1资料与方法
1.1 一般资料
研究对象是2020年1月至2020年7月在我院行超声检查的部分患者,时限为患者入院7天内,测算其心脏超声参数。将AMI患者32例及心功能正常者(无高血压、糖尿病、心脏相关疾病)34例分组为A、B组。A组中男21例,女11例,年龄(64.19±10.32)岁,体重(65. 08±10.27)kg,身高(165.16±8.01)cm;B组中男16例,女18例,年龄(61.18±8.26)岁,体重(60.41±9.17)kg,身高(163.88±7.54)cm。A组AMI的诊断经心肌酶、心电图及冠状动脉造影等确诊,排除已有心房颤动、中度以上瓣膜病、心肌病、阻塞性或限制性肺病的受试者。
1.2 方法
采用PHILIPS EPIQ7C型心脏超声诊断仪,X5-1 探头,被检者均接上胸导联心电图,取左侧卧位,在患者平稳呼吸期间应用常规二维超声记录三个连续的心动周期,留取其心尖四腔心及两腔心动态图像。最后应用Echo Pac软件脱机分析,应用斑点追踪技术分别在四腔心及两腔心切面上手动描绘左房、左室内膜曲线,系统自动勾划感兴趣区,若追踪不满意则可手动调节,系统自动得出相应各节段的应变曲线。在相应图像上测量并计算出平均LAd、LAVmax、LAVmin、LAVp、LVEF、SRs、SRe、SRa。处理数据得出LAVI及左房射血分数相关的数值。
1.3 统计学处理
采用SPSS 26.0软件进行统计学分析,计量资料采用() 表示,均数比较采用独立样本t检验,相关性检验采用Pearson相关分析。P<0.05为差异有统计学意义。
2结果
2. 1 患者超声参数的比较
A组患者LAd、LAVmax、LAVmin、LAVp、LAVI水平显著高于B组(P<0.05),LAPEF、LAAEF、LATEF、LVEF、SRs、SRe、SRa及GLAS水平显著低于B组(P<0.05)。见表1。
2.2 LAVI与年龄、应变力的相关性分析
LAVI与年龄、SRa分别存在正相关关系(r=0.380,0.539 ,P<0.05),与SRs、GLAS分别存在负相关关系(r=-0.413,-0.516 ,P<0.05),与SRe相关性不明显(r=0.231 ,P>0.05)。见表2。
3讨论
AMI患者的心肌僵硬度会不断增加,使左室充盈压逐渐升高,左房长期代偿性增加做功刺激左房重构,降低了左房射血的能力[4]。左房扩张能缩短左房不应期,增高心律失常发生的风险,左房室壁的牵拉扩张也使其对神经激素的分泌增加,这均促进心脏不良事件出现 [5]。左房容积及应变的改变能反映AMI患者的左房扩张、左室充盈压升高及左室舒张功能恶化[6-9]。Hsiao、Cameli等[10-11] 认为左房容积、应变力分别能预测AMI患者预后及左室舒张压升高。
本研究结果中,A组患者LAd、LAVmax、LAVmin、LAVp、LAVI水平显著高于B组(P<0.05), LAPEF、LAAEF、LATEF、LVEF水平明显低于B组(P<0.05),提示A组患者左房容积明显增大,左房舒张及射血功能明显减弱,表明A组患者左房重构及功能减退更严重。SRs、SRe及SRa水平分别反映左房的储存器、管道及辅助泵功能[12-13]。A组患者SRs、SRe、SRa及GLAS水平明显低于B组 ( P < 0. 05),表明左房扩张重构使AMI患者左房的储蓄、管道、辅助泵功能严重受损甚至失代偿。有研究表明[6],左房扩张及左室充盈量减低,会促进AMI患者出现心脏不良事件,这使得对左房功能的研究显得更有价值。本研究中患者LAVI与年龄、SRa呈正相关(r=0.380,0.539 ,P<0.05),与SRs、GLAS呈负相关(r=-0.413,-0.516 ,P<0.05),与SRe相关性不显著(r=0.231 ,P>0.05)。这表明随着患者年龄的增大其左房收缩功能会降低,且左房容积的增大会伴随其收缩应变功能的减退,左房容积与应变参数之间有较好的相关性。
4结论
本研究发现AMI患者左房功能显著减退,其年龄、SRa、SRs、GLAS等超声参数与LAVI有很强的相关性。STI受测量角度、混响、旁瓣和脱落伪影的影响较小[14],能相对精准地检测出心肌功能的变化,可更准确地评估AMI患者的左房功能。
参考文献
[1]成志远. 三维超声心动图在急性心肌梗死患者左心房功能评估中的应用分析[J].中西医结合心血管病杂志,2016,4(16):25-26.
[2]周洁莹,王建华,张敏郁,丁桂春,刘欣.实时三维超声心动图左心房容积成像评价高血压患者左心室舒张功能[J].中国医学影像技术,2009,25(11):2140-2141.
[3] Almeida Ana G. The Importance of Left Atrial Function for Prognosis after Acute Myocardial Infarction.[J]. Radiology,2019,293(2). [4] 邹文,杨彦青,邹满花,等.左心房容积指数在预测急性非ST段抬高型心肌梗死预后中的价值[J].实用临床医学,2016,17(9):49-52.
[5]Jacob E. M?ller,Graham S. Hillis,Patricia A.
Pellikka,James B. Seward,Guy S. Reeder,R. Scott Wright,Seung W. Park,Jae K. Oh. Left atrial volume: A powerful predictor of survival after acute myocardial infarction[J]. Journal of the American College of Cardiology,2003,41(6).
[6]朱佳,楊性安,王刚,林仙方.二维斑点追踪超声心动图评价急性心肌梗死患者左心房应变功能[J].心脑血管病防治,2015,15(02):131-132.
[7]Rine Bakkestr?m,Mads J. Andersen,Mads Ersb?ll,John Bro-Jeppesen,Finn Gustafsson,Lars K?ber,Christian Hassager,Jacob E. M?ller. Early changes in left atrial volume after acute myocardial infarction. Relation to invasive hemodynamics at rest and during exercise[J]. International Journal of Cardiology,2016,223.
[8]C.P. Appleton,J.M. Galloway,M.S. Gonzalez,M. Gaballa, M.A. Basnight,Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction,J. Am. Coll. Cardiol. 22 (1993) 1972–1982.
[9] M.A.Basnight,M.S. Gonzalez,S.C. Kershenovich,C.P. Appleton, Pulmonary venous flow velocity: relation to hemodynamics,mitral flow velocity and left atrial volume,and ejection fraction,J. Am. Soc. Echocardiogr. 4 (1991) 547–558.
[10]Hsiao Shih-Hung,Chu Kuo-An,Wu Chieh-Jen,Chiou Kuan-Rau. Left Atrial Expansion Index Predicts Left Ventricular Filling Pressure and Adverse Events in Acute Heart Failure With Severe Left Ventricular Dysfunction.[J]. Journal of cardiac failure,2016,22(4).
[11]Matteo Cameli,Matteo Lisi,Sergio Mondillo,Margherita Padeletti,Piercarlo Ballo,Charilaos Tsioulpas,Sonia Bernazzali,Massimo Maccherini. Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure[J]. ,2010,8(1).
[12]贾静静,董平栓.急性心肌梗死对左心房的影响[J].心血管病学进展,2014,35(06):685-688.
[13]Rafal Dabrowski,Anna Borowiec,Edyta Smolis-Bak,Ilona Kowalik,Cezary Sosnowski,Alicja Kraska,Barbara Kazimierska,Jacek Wozniak,Wojciech Zareba,Hanna Szwed. Effect of Combined Spironolactone–β-Blocker ± Enalapril Treatment on Occurrence of Symptomatic Atrial Fibrillation Episodes in Patients With a History of Paroxysmal Atrial Fibrillation (SPIR-AF Study)[J]. The American Journal of Cardiology,2010,106(11).
[14] Chunlai Shao,Jing Zhu,Jianchang Chen,Weiting Xu. Independent prognostic value of left atrial function by two-dimensional speckle tracking imaging in patients with non -ST-segment-elevation acute myocardial infarction[J]. ,2015,15(1).
作者简介:
(1)第一作者:柴文文,女,汉,1994年1月生,湖省随州人,研究生在读,研究方向:影像医学与核医学心脏超声方向。
(2)通讯作者:陈各才,男,汉,1979年12月生,江苏泰州人,硕士,研究方向:心血管疾病治疗及介入治疗