实时三维超声心动图与左房追踪技术评价不同左心室构型原发性高血压患者左心房的容积与功能

摘要

Objective: To evaluate the change of left atrial volume and function in essential hypertension(EH) patients with different patterns of left ventricular geometric models using RT-3DE and LA tracking (LAT). Methods: 133 patients with EH were divided into four groups according to Ganau: normal pattern group (group Ⅰ ), concentric remodeling pattern group(group Ⅱ), concentric hypertrophy pattern group (group Ⅲ), eccentric hypertrophy pattern group (group Ⅳ). 33 control subjects were enrolled. RT-3DE was used to measure maximal volume, minimal volume, stroke volume, conduit volume and ejection fraction of the left atrium. According to the time-volume curve obtained by LAT, LAVmax', LAVmin', LA presystolic volume(Lapre) were measured. And then LASV', LAEF' and LA passive emptying volume(LAVp) were calculated. The difference between the control group and EH group was compared. Results: Compared with the control group, LAVmax, LAVmin, LASV, LAEF, LAVmax', LAVmin', LASV, LAEF' in EH group Ⅰncreased, but LACV and LAVp decreased(P<0.05). Comparison within the EH groups: All parameters in the group Ⅲ and group Ⅳ markedly increased than other groups (P<0.01). LAEF was lower in group Ⅳ than group Ⅲ(P<0.05). There was no difference of LACV and LAVp between group Ⅱ and group Ⅰ (P>0.05). Conclusion: Left atrial reservoir function and booster pump function increase in normal pattern of left ventricular geometric models, while left atrial conduit function decreases. Left atrial booster pump function decreases in eccentric hypertrophy pattern. There is no significant difference of left atrial booster pump function between group Ⅰ and group Ⅱ . Combination of RT-3DE and LAT technology can evaluate the left atrial volume and function of hypertension accurately.%目的:应用实时三维超声心动图(Real-time three-dimensional echocardiography,RT-3DE)及左房追踪技术(Left atrial tracking,LAT)评价不同左心室构型原发性高血压(Essential hypertension,EH)患者左心房容积与功能的变化.方法:正常对照组32例和原发性高血压(EH组)患者133例,按Ganau法将EH组分为:正常左室构型组(Ⅰ组)、向心性重构组(Ⅱ组)、向心性肥厚组(Ⅲ组)、离心性肥厚组(Ⅳ组).应用RT-3DE技术获得左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房每搏量(LASV)、左心房射血分数(LAEF)、左心房管道容积(LACV).应用LAT技术获得左心房容积-时间曲线测量得到:LAVmax’、LAVmin’、左心房收缩前容积(LAVpre)；根据公式计算得到:LASV’、LAEF’、左心房被动排空容积(LAVp).比较EH各组与对照组、EH组内的差异性.结果:①EH组LAVmax、LAVmin、LASV、LAEF、LAVmax’、LAVmin’、LASV’、LAEF’值高于对照组,LACV、LAVp值小于对照组.②EH组内:向心性肥厚组(Ⅲ组)和离心性肥厚组(Ⅳ组)各参数变化明显(P＜0.01),LAEF与LAEF’值在离心性肥厚组(Ⅳ组)较向心性肥厚组(Ⅲ组)减低(P＜0.05)；向心性重构组(Ⅱ组)LACV与LAVp值较正常左室构型组(Ⅰ组)略有减少,但差异无统计学意义(P＞0.05).结论:高血压早期即正常左室构型时左心房储存功能及助力泵功能增加,管道功能减低；离心性肥厚阶段左心房助力泵功能减低.正常左室构型与向心性重构阶段左心房管道功能无变化.RT-3DE及LAT两种技术相结合可以很好的评价不同左室构型EH左心房的容积与功能.