斑点追踪技术评价高血压病患者房间隔厚度与左心房功能关系的初步研究

目的 利用二维斑点追踪技术（2D-STI）评价原发性高血压患者左心房功能与房间隔厚度的关系。方法 高血压患者41例（左房重构组LAR20例、左房非重构组LAN21例）和25名健康体检者,运用2D-STI技术测得左房收缩期、舒张早期、舒张晚期左心房平均应变率（mSRs、mSRe、mSRa），运用RT-3DE（实时三维容积成像技术）结合心电图时相获取左房最大容积（LAVmax）、左房收缩前容积（LAVpre）、左房最小容积（LAVmin），并计算得出左房被动排空指数LAEFpassive、左房主动排空指数LAEFactive及左房总排空分数LAEF。M型超声测量收缩期房间隔厚度（IASTs）及舒张期房间隔厚度（IASTd），计算房间隔增厚率ASTDF（%）。观察各组间数据有无差异，并对房间隔增厚率与左房主动排空指数、舒张晚期平均应变率及左房总排空分数之间进行相关性分析。结果 与对照组相比，LAN组的mSRs、mSRe、LAEFp、LAEF均减低，mSRa、LAEFa及ASTDF均增高，P均<0.05，差异有统计学意义；与LAN组相比，LAR组的mSRs、mSRe、LAEFp、LAEF均减低，mSRa、LAEFa及ASTDF均增高，P均<0.05，差异有统计学意义；房间隔增厚率与左房主动排空指数、舒张晚期平均应变率及左房总排空分数之间均存在正相关性，P<0.05。结论 高血压患者早期左心房功能已经开始减退，二维斑点追踪技术能够早期发现原发性高血压病程中左心房结构和功能的改变；房间隔厚度及增厚率与左心房功能间具有正相关性，房间隔厚度及增厚率可以作为左房功能早期改变的补充预测指标。

Evaluation of the relationship between atrial septal thickness and left atrial function in patients with essential hypertension by speckle tracking technique

Objective 2D-STI was used to evaluate the relationship between atrial septal thickness and left atrial structure and function in patients with essential hypertension. Methods Forty one patients with hypertension (LAR 20 cases in left atrial remodeling group and 21 cases in left atrial non remodeling group) and 25 healthy subjects were enrolled in this study, The mean strains rates (mSRs, mSRe, mSRa) of left atrial wall and atrial septum were measured by 2D-STI technique. RT-3DE (real-time three-dimensional volume imaging) combined with ECG phase was used to obtain the left atrial maximum volume (LAVmax), left atrial pre systolic volume (LAVpre), left atrial minimum volume (LAVmin), and the left atrial passive emptying index (LAEFpassive), left atrial active emptying index (LAEFactive) and left atrial dilation index (LAEF) were calculated.Systolic atrial septal thickness (IASTs) and diastolic atrial septal thickness (IASTd) were measured by M-mode ultrasound, and the atrial septal thickening rate (ASTDF (%) ) was calculated.The correlation between the thickening rate of atrial septum and left atrial active emptying index, average late diastolic strain rate and total left atrial emptying fraction was analyzed.Results Compared with the control group, The levels of mSRs, mSRe, LAEFp and LAEF in the LAN group were all decreased. mSRa,LAEFa and ASTDF all increased, P <0.05, and the difference was statistically significant. The LAR group is compared to the LAN group, mSRs, mSRe, LAEFp and LAEF were all decreased with P <0.05.There was a significant positive correlation between atrial septal thickening rate and left atrial active emptying index, average late diastolic strain rate and left atrial total emptying fraction (P < 0.05).Conclusions The left atrial function has begun to decline in patients with hypertension at the early stage. The thickness and thickening rate of atrial septum have significant positive correlation with left atrial function. Atrial septal thickness and thickening rate can be used as supplementary predictors of early changes in left atrial function.