实时三维超声心动图联合二维斑点追踪显像技术评价冠状动脉慢血流患者左房结构及相位功能改变

 目的 探讨实时三维超声心动图（real-time three-dimensional echocardiography，RT-3DE）联合二维斑点追踪显像技术（two-dimensional speckle tracking imaging，2D-STI）评价冠状动脉慢血流（coronary slow flow，CSF）患者左房结构及相位功能的应用价值。方法 选取2016年11月至2019年2月在复旦大学附属中山医院经冠状动脉造影（coronary angiography，CAG）确诊的CSF患者32例（CSF组）及CAG结果正常者30例（对照组），采集两组入选对象的常规二维超声及三维全容积图像，通过RT-3DE获取左房最大容积（left atrial maximum volume，LAVmax）、左房收缩前容积（left atrial pre-atrial contraction volume，LAVpreA）及左房最小容积（left atrial minmum volume，LAVImin）经体表面积标准化后得到左房最大容积指数（LAVmax index，LAVImax）、左房收缩前容积指数（LAVpreA index，LAVIpreA）及左房最小容积指数（LAVmin index，LAVImin），通过2D-STI获取左房舒张早期、收缩期及舒张晚期的平均峰值应变（LAScd、LASr、LASct）及应变率（pLASRcd、pLASRr、pLASRct），分析上述获取的左房参数并进行组间比较。结果 两组间常规超声心动图参数差异无统计学意义。与对照组相比，CSF组LAVImax、LAVIpreA、LAVImin增大，但左房总射血分数（LA total emptying fraction，LATEF）、左房被动射血分数（LA passive emptying fraction，LAPEF）、LASr、LAScd、pLASRr、pLASRcd均降低（P均<0.05）。相关性分析提示CSF患者LATEF与LASr/pLASRr，LAPEF与LAScd/pLASRcd，左房主动射血分数（LA active emptying fraction，LAAEF）与pLASRct均呈正相关（P均<0.05）。结论 CSF患者左房增大且存在储器功能及传导功能受损。RT3DE联合2DSTI可更加准确地定量评估CSF患者早期左房结构及相位功能的改变。

Evaluation of left atrial structure and phasic functions in patients with coronary slow flow using real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging

Objective To evaluate the left atrial structure and phasic functions by using real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI) in patients with coronary slow flow (CSF). Methods A total of 32 patients with CSF confirmed by coronary angiography and 30 controls with normal CAG were recruited from Zhongshan Hospital from Nov 2016 to Feb 2019. RT3DE was used to calculate the left atrial maximum volume (LAVmax), left atrial pre-atrial contraction volume (LAVpreA) and left atrial minimum volume (LAVmin). After normalization of the body surface area, LAVmax index (LAVImax), LAVpreA index (LAVIpreA) and LAVmin index (LAVImin) were obtained. The mean peak strain and strain rate during LA systole (LASr, pLASRr), during early diastole (LAScd, pLASRcd) and during late diastole (LASct, pLASRct) were measured using 2D-STI. The LA parameters obtained above were analysed and compared between the two groups. Results Conventional echocardiographic parameters did not differ in the two groups. Compared with control group, LAVImax, LAVImin and LAVIpreA were found to be increased in CSFP patients. However, LATEF, LAPEF, LASr, LAScd, pLASRr and pLASRcd were found to be lower in CSFP patients than in controls. Correlation analysis showed that LATEF was positively correlated with LASr and pLASRr, LAPEF was positively correlated with LAScd and pLASRcd, and LAAEF was positively correlated with pLASRct in CSF patients (all P<0.05). ConclusionPatients with CSFP were found to have enlarged LA volumes and impaired LA reservoir and conduit functions. RT-3DE combined with 2D-STI can accurately and quantitatively evaluate the early changes of LA structure and phasic functions in CSF patients.