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目的应用实时三维超声心动图(RT-3DE)评价舒张性心力衰竭(DHF)患者左房容积及功能的变化及其临床应用价值。方法 DHF患者68例。按NYHA分级分为NYHAⅡ级组(33例)、Ⅲ级组(21例)、Ⅳ级组(14例)3个亚组。对照组41例。常规测量二尖瓣口前向峰值流速E和二尖瓣环峰值速度E′,计算E/E′值。采用RT-3DE测量左房最大容积(LAVmax)、最小容积(LAVmin)及收缩前容积(LAVpreA),并用体表面积校正(LAVImax、LAVImin、LAVIpreA),计算左房整体射血分数(LAEF)、被动射血分数(LAPEF)、主动射血分数(LAAEF)。应用ELISA法测量研究对象血浆心房利钠肽(ANP)水平。结果 LAVImax、LAVImin、LAVIpreA、ANP水平在DHF患者中增大,且随着心功能级数的增加而增加(P<0.05);LAEF在DHF患者中减小,且随着心功能级数的增加而降低(P<0.05);LAAEF在NYHAⅡ级组中最大,对照组次之,在NYHAⅣ级组中最小(P<0.05);LAPEF在DHF患者中降低,对照组和DHF各亚组间差异均有统计学意义,在DHF各亚组间差异无统计学意义。DHF患者的LAVImax、LAVImin、LAVIpreA与E/E′、ANP水平分别呈正相关(P<0.05),LAEF、LAPEF、LAAEF与E/E′、ANP水平分别呈负相关(P<0.05)。结论 RT-3DE能有效评价DHF患者左房容积及功能的变化,并间接反映左室舒张功能的改变。
Objective To evaluate the changes of left atrium volume and function in patients with diastolic heart failure (DHF) by real-time three-dimensional echocardiography (RT-3DE) and its clinical value. Methods 68 cases of DHF patients. According to NYHA classification, there were 3 subgroups: NYHAⅡgroup (33 cases), Ⅲgroup (21 cases), Ⅳgroup (14 cases). Control group of 41 cases. E / E ’values were routinely measured by measuring the mitral valve anterior peak flow velocity E and the mitral annulus peak velocity E’. Left atrium LAVmax, LAVmin and LAVpreA were measured by RT-3DE, and left atrial total ejection fraction (LAEF) was calculated by body surface area correction (LAVImax, LAVImin, LAVIpreA) Ejection ejection fraction (LAPEF), active ejection fraction (LAAEF). The level of plasma atrial natriuretic peptide (ANP) was measured by ELISA. Results The levels of LAVImax, LAVImin, LAVIpreA and ANP increased in patients with DHF and increased with the increase of cardiac function (P <0.05). LAEF decreased in patients with DHF, and with the increase of cardiac function (P <0.05). LAAEF was the largest in NYHAⅡgroup, followed by control group, the lowest in NYHAⅣgroup (P <0.05), LAPEF was decreased in DHF patients, and the differences between control group and DHF subgroup were There was statistical significance, there was no significant difference among the subgroups of DHF. The levels of LAVImax, LAVImin, LAVIpreA and E / E ’, ANP in DHF patients were positively correlated (P <0.05). The levels of LAEF, LAPEF, LAAEF and E / E’ ANP were negatively correlated (P <0.05). Conclusion RT-3DE can effectively evaluate the changes of left atrium volume and function in patients with DHF and indirectly reflect the changes of left ventricular diastolic function.