RT-3DE对阻塞性睡眠呼吸暂停综合征不同左室构型患者左房结构和功能的评价
|
摘要
目的应用实时三维超声心动图(RT-3DE)技术评价阻塞性睡眠呼吸暂停综合征(OSAS)不同左室构型患者的左房结构和功能,探讨左房结构和功能参数与左室构型的关系。方法选取我院确诊的OSAS患者121例和同期健康成人42例(N组),均行血压、血糖、血脂及超声心动图检查,依据左室质量指数和相对室壁厚度,将OSAS患者分为四组:正常构型组(NG组)62例、向心性重构组(CR组)17例、向心性肥厚组(CH组)31例、离心性肥厚组(EH组)11例。分析各组全容积图像并获取左房容积-时间曲线,得到左房最大容积(LAVmax)、左房最小容积(LAVmin)和左房收缩前容积(LAVpre-a),计算左房总排空容积(LA TotEV)、总排空分数(LA TotEF)、被动排空容积(LA PassEV)、被动排空分数(LA PassEF)、主动排空容积(LA ActEV)和主动排空分数(LA ActEF),比较各组上述左房结构和功能参数的差异。结果①结构参数:NG组标化LAVmax较N组增加,CR组LAVmax、LAVmin、LAVpre-a、标化LAVpre-a较N组和NG组均增加,EH组和CH组LAVmax、标化LAVmax、LAVmin、标化LAVmin、LAVpre-a、标化LAVpre-a较N组、NG组和CR组均增加,差异均有统计学意义(均P<0.05)。②储存功能参数:CR组、EH组和CH组LA TotEV较N组和NG组均增加,EH组和CH组LATotEV较CR组均增加,差异均有统计学意义(均P<0.05)。③管道功能参数:EH组和CH组LAPassEF较N组、NG组和CR组均降低,差异均有统计学意义(均P<0.05)。④助力泵功能参数:CR组、EH组和CH组LA ActEV较N组均增加,NG组、CR组、EH组和CH组LA ActEF较N组均增加;CH组、EH组LA ActEF较NG组均增加,CR组、EH组和CH组LA ActEV较NG组均增加;CH组LA ActEV和LA ActEF较CR组均增加,差异均有统计学意义(均P<0.05)。结论不同左室构型OSAS患者其左房结构和功能不同,左房结构和功能参数随左室构型的变化而变化,提示临床应早期重视左房的改变,有一定的应用价值。
Objective To evaluate left atrial(LA)structure and function of different left ventricular geometry in patients with obstructive sleep apnea syndrome(OSAS)by real-time three-dimensional echocardiography(RT-3 DE),and to explore the relationship between left atrial structure and functional parameters and left ventricular geometry. Methods A total of 121 patients with OSAS were diagnosed in our hospital,At the same time,42 healthy adults were selected(N group). Blood pressure,blood glucose,blood lipids were collected and echocardiography was performed next morning. According to the left ventricular mass index and relative wall thickness,OSAS patients were divided into 4 groups:normal geometry(NG group)62 cases,concentric remodeling(CR group)17 cases,eccentric hypertrophy(EH group)31 cases,concentric hypertrophy(CH group)11 cases.Full volume images at apical four-chamber view were collected,and LA volume-time curve was drawn,LA maximum volume(LAVmax),LA minimum volume(LAVmin),LA pre-contraction volume(LAVpre-a) were analyzed.Following parameters including LA total emptying volume(LA TotEV),LA total emptying fraction(LA TotEF),LA passive emptying volume(LA PassEV),LA passive emptying fraction(LA PassEF),LA active emptying volume(LA ActEV),LA active emptying fraction(LA ActEF)were calculated.The differences in structural and functional parameters of the above groups were compared. Results ① Structural parameters:compared with N group,LAVmax/BSA increased in NG group(P<0.05).Compared with N group and NG group,LAVmax,LAVmin,LAVpre-a,LAVpre-a/BSA increased in CR group(all P<0.05).Compared with N group,NG group and CR group,LAVmax,LAVmax/BSA,LAVmin,LAVmin/BSA,LAVpre-a,LAVpre-a/BSA increased in EH group and CH group(all P<0.05).② Reservoir function parameters:compared with N group and NG group,LA TotEV increased in CR group,EH group and CH group(all P<0.05).Ccompared with CR group,LA TotEV increased in EH group and CH group(both P<0.05).③ Conduit function parameters:compared with N group,NG group and CR group,LA PassEF decreased in EH group and CH group(all P<0.05).④ Pump function parameters:compared with N group,LA TotEV increased in CR group,EH group and CH group, LA ActEF increased in NG group,CR group,EH group and CH group(all P<0.05). Compared with NG group,LA ActEF increased in EH group and CH group,LA ActEV increased in CR group,EH group and CH group(all P<0.05).Compared with CR group,LA ActEV and LA ActEF increased in CH group(both P<0.05).Conclusion Different left ventricular geometric has different LA structure and function in OSAS.LA structure and functional parameters change with the changes in left ventricular geometry,suggesting that clinical attention should be paid to the changes of left atrium in the early stage,which has certain clinical application value.
Objective To evaluate left atrial(LA)structure and function of different left ventricular geometry in patients with obstructive sleep apnea syndrome(OSAS)by real-time three-dimensional echocardiography(RT-3 DE),and to explore the relationship between left atrial structure and functional parameters and left ventricular geometry. Methods A total of 121 patients with OSAS were diagnosed in our hospital,At the same time,42 healthy adults were selected(N group). Blood pressure,blood glucose,blood lipids were collected and echocardiography was performed next morning. According to the left ventricular mass index and relative wall thickness,OSAS patients were divided into 4 groups:normal geometry(NG group)62 cases,concentric remodeling(CR group)17 cases,eccentric hypertrophy(EH group)31 cases,concentric hypertrophy(CH group)11 cases.Full volume images at apical four-chamber view were collected,and LA volume-time curve was drawn,LA maximum volume(LAVmax),LA minimum volume(LAVmin),LA pre-contraction volume(LAVpre-a) were analyzed.Following parameters including LA total emptying volume(LA TotEV),LA total emptying fraction(LA TotEF),LA passive emptying volume(LA PassEV),LA passive emptying fraction(LA PassEF),LA active emptying volume(LA ActEV),LA active emptying fraction(LA ActEF)were calculated.The differences in structural and functional parameters of the above groups were compared. Results ① Structural parameters:compared with N group,LAVmax/BSA increased in NG group(P<0.05).Compared with N group and NG group,LAVmax,LAVmin,LAVpre-a,LAVpre-a/BSA increased in CR group(all P<0.05).Compared with N group,NG group and CR group,LAVmax,LAVmax/BSA,LAVmin,LAVmin/BSA,LAVpre-a,LAVpre-a/BSA increased in EH group and CH group(all P<0.05).② Reservoir function parameters:compared with N group and NG group,LA TotEV increased in CR group,EH group and CH group(all P<0.05).Ccompared with CR group,LA TotEV increased in EH group and CH group(both P<0.05).③ Conduit function parameters:compared with N group,NG group and CR group,LA PassEF decreased in EH group and CH group(all P<0.05).④ Pump function parameters:compared with N group,LA TotEV increased in CR group,EH group and CH group, LA ActEF increased in NG group,CR group,EH group and CH group(all P<0.05). Compared with NG group,LA ActEF increased in EH group and CH group,LA ActEV increased in CR group,EH group and CH group(all P<0.05).Compared with CR group,LA ActEV and LA ActEF increased in CH group(both P<0.05).Conclusion Different left ventricular geometric has different LA structure and function in OSAS.LA structure and functional parameters change with the changes in left ventricular geometry,suggesting that clinical attention should be paid to the changes of left atrium in the early stage,which has certain clinical application value.
引文
[1] Zamarrón C,Valdés Cuadrado L,Alvarez-Sala R. Pathophysiologic mechanisms of cardiovascular disease in obstructive sleep apnea syndrome[J]. Pulm Med,2013:521087.doi:10.1155/2013/521087.
[2] Lavie CJ,Patel DA,Milani RV,et al.Impact of echocardiographic left ventricular geometry on clinical prognosis[J].Prog Cardiovasc Dis,2014,57(1):3-9.
[3] ThomasL,AbhayaratnaWP.Leftatrialreverseremodelingmechanisms evaluation and clinical significance[J].JACC Cardiovasc Imaging,2017,10(1):65-77.
[4]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(3):9-12.
[5] Lang RM,Bierig M,Devereux RB,et al. Recommendations for chamber quantification[J].Eur J Echocardiogr,2006,7(2):79-108.
[6]盛媛媛,李萌萌,李晓艺,等.中国成人高血压左心室构型特点与国际标准构型差异的超声心动图对比分析[J].中华超声影像学杂志,2018,27(6):461-466.
[7] Ganau A,Devereux RB,Roman MJ,et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension[J].J Am Coll Cardiol,1992,19(7):1550-1558.
[8] Tadic M,Cuspidi C.The influence of left ventricular geometry on left atrial Phasic function in hypertensive patients[J].Blood Press,2015,24(6):361-368.
[9] Wu VC,Takeuchi M,Kuwaki H,et al.Prognostic value of LA volumes assessed by transthoracic 3D echocardiography:comparison with 2D echocardiography[J].JACC Cardiovasc Imaging,2013,6(10):1025-1035.
[10] Patel DA,Lavie CJ,Milani RV,et al. Association of left ventricular geometry with left atrial enlargement in patients with preserved ejection fraction[J].Congest Heart Fail,2012,18(1):4-8.
[11]张荔,吕清,谢明星,等.实时三维超声心动图评价左心室不同构型的高血压患者左心容积功能[J].中华医学超声杂志(电子版),2012,9(2):110-116.
[2] Lavie CJ,Patel DA,Milani RV,et al.Impact of echocardiographic left ventricular geometry on clinical prognosis[J].Prog Cardiovasc Dis,2014,57(1):3-9.
[3] ThomasL,AbhayaratnaWP.Leftatrialreverseremodelingmechanisms evaluation and clinical significance[J].JACC Cardiovasc Imaging,2017,10(1):65-77.
[4]中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(3):9-12.
[5] Lang RM,Bierig M,Devereux RB,et al. Recommendations for chamber quantification[J].Eur J Echocardiogr,2006,7(2):79-108.
[6]盛媛媛,李萌萌,李晓艺,等.中国成人高血压左心室构型特点与国际标准构型差异的超声心动图对比分析[J].中华超声影像学杂志,2018,27(6):461-466.
[7] Ganau A,Devereux RB,Roman MJ,et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension[J].J Am Coll Cardiol,1992,19(7):1550-1558.
[8] Tadic M,Cuspidi C.The influence of left ventricular geometry on left atrial Phasic function in hypertensive patients[J].Blood Press,2015,24(6):361-368.
[9] Wu VC,Takeuchi M,Kuwaki H,et al.Prognostic value of LA volumes assessed by transthoracic 3D echocardiography:comparison with 2D echocardiography[J].JACC Cardiovasc Imaging,2013,6(10):1025-1035.
[10] Patel DA,Lavie CJ,Milani RV,et al. Association of left ventricular geometry with left atrial enlargement in patients with preserved ejection fraction[J].Congest Heart Fail,2012,18(1):4-8.
[11]张荔,吕清,谢明星,等.实时三维超声心动图评价左心室不同构型的高血压患者左心容积功能[J].中华医学超声杂志(电子版),2012,9(2):110-116.