左心室舒张功能不全患者左心房僵硬度指数与左心室舒张功能和N末端B型利钠肽前体的相关性
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摘要
目的:探究左心室舒张功能不全患者左心房僵硬度指数(left atrial stiffness index,LASI)与左心室舒张功能及血浆N末端B型利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-pro BNP)浓度的关系,明确其在左心室舒张功能不全方面的临床意义。方法:选取2015年8月至2016年2月在中南大学湘雅二医院经超声检查确诊的左心室舒张功能不全患者58例,分为左心室无肥厚组(30例)与左心室肥厚组(28例),随机选取健康正常人30例为对照组,超声测量并计算所有入选组的二尖瓣瓣口舒张早期峰值血流速度/二尖瓣瓣口舒张中晚期峰值血流速度(E/A)、E/二尖瓣舒张早期峰值运动速度(E/é)、LASI值,同时检测两组的血浆NT-pro BNP浓度,最后将测得的LASI分别与E/A,E/é及NT-pro BNP作相关性分析。结果:血浆NT-pro BNP浓度在对照组、左心室无肥厚组、左心室肥厚组组间差异无统计学意义(P>0.05);左心室肥厚组、左心室无肥厚组E/A均低于对照组;E/é均高于对照组;左心室肥厚组E/é较左心室无肥厚组更高;左心室肥厚组、左心室无肥厚组LASI均高于对照组;左心室肥厚组LASI较左心室无肥厚组更高,差异均有统计学意义(均P<0.05)。LASI与E/é呈正相关(r=0.575,P=0.023);L A SI与E/A呈负相关(r=-0.481,P=0.021);L A SI与NT-pro BNP不相关(r=0.078,P=0.472)。结论:LASI可反映左心室舒张功能不全患者左心室舒张功能。LASI与血浆NT-pro BNP浓度无关。
Objective: To investigate the relationship between left atrial stiffness index(LASI) and left ventricular diastolic function and N-terminal pro-brain natriuretic peptide(NT-pro BNP) in patients with left ventricular diastolic dysfunction and to evaluate the value of LASI in the term of patients with left ventricular diastolic dysfunction. Methods: Fifty-eight patients with left ventricular diastolic dysfunction diagnosed echocardiogram were divided into two groups by with(28 cases) or without(30 cases) left ventricular hypertrophy. Thirty normal people were chosen as an age-matched control group. The concentration of NT-pro BNP was measured by immunofluorescence method. The E/A, E/é and LASI were detected by echocardiogram and calculated. The correlation between LASI and E/A and E/é was analyzed. Results: There concentration of NT-pro BNP was no significant difference between patients with left ventricular diastolic dysfunction and in the control group(P>0.05). LASI both in left ventricular diastolic dysfunction with and without left ventricular hypertrophy were significantly higher than that in the control group; LASI in left ventricular diastolic dysfunction with left ventricular hypertrophy was significantly higher than that without left ventricular hypertrophy; E/é both in left ventricular diastolic dysfunction with and without left ventricular hypertrophy was significantly higher than that in the control group; E/é in left ventricular diastolic dysfunction with left ventricular hypertrophy was significantly higher than that without left ventricular hypertrophy; E/A both in left ventricular diastolic dysfunction with and without left ventricular hypertrophy were significantly lower than that in the control group, the differences were statistically significant(all P<0.05). LASI was positively related to E/é(r=0.575, P=0.023). LASI was negatively related to E/A(r=-0.481, P=0.021). LASI was not related to the concentration of NT-pro BNP(r=0.078, P=0.472). Conclusion: LASI can reflect left ventricular diastolic function. There is no relationship between LASI and the concentration of NTpro BNP.
Objective: To investigate the relationship between left atrial stiffness index(LASI) and left ventricular diastolic function and N-terminal pro-brain natriuretic peptide(NT-pro BNP) in patients with left ventricular diastolic dysfunction and to evaluate the value of LASI in the term of patients with left ventricular diastolic dysfunction. Methods: Fifty-eight patients with left ventricular diastolic dysfunction diagnosed echocardiogram were divided into two groups by with(28 cases) or without(30 cases) left ventricular hypertrophy. Thirty normal people were chosen as an age-matched control group. The concentration of NT-pro BNP was measured by immunofluorescence method. The E/A, E/é and LASI were detected by echocardiogram and calculated. The correlation between LASI and E/A and E/é was analyzed. Results: There concentration of NT-pro BNP was no significant difference between patients with left ventricular diastolic dysfunction and in the control group(P>0.05). LASI both in left ventricular diastolic dysfunction with and without left ventricular hypertrophy were significantly higher than that in the control group; LASI in left ventricular diastolic dysfunction with left ventricular hypertrophy was significantly higher than that without left ventricular hypertrophy; E/é both in left ventricular diastolic dysfunction with and without left ventricular hypertrophy was significantly higher than that in the control group; E/é in left ventricular diastolic dysfunction with left ventricular hypertrophy was significantly higher than that without left ventricular hypertrophy; E/A both in left ventricular diastolic dysfunction with and without left ventricular hypertrophy were significantly lower than that in the control group, the differences were statistically significant(all P<0.05). LASI was positively related to E/é(r=0.575, P=0.023). LASI was negatively related to E/A(r=-0.481, P=0.021). LASI was not related to the concentration of NT-pro BNP(r=0.078, P=0.472). Conclusion: LASI can reflect left ventricular diastolic function. There is no relationship between LASI and the concentration of NTpro BNP.
引文
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6.Machino-Ohtsuka T,Seo Y,Tada H,et al.Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation[J].J Cardiovasc Electrophysiol,2011,22(9):999-1006.
7.Di Salvo,Caso P,Lo Piccolo,et al.Atrial myocardial deformation proper ties predict maintenance of sinus rhy thm after external cardioversion of recent-onset lone atrial fibrillation:a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study[J].Circulation,2005,112(3):387-395.
8.Hoit BD,Walsh RA.Regional atrial distensibility[J].Am J Physiol,1992,262(5 Pt 2):H1356-H1360.
9.Demir M,Akta??,?amci S.Left atrial mechanical function and stiffness in patients with atrial septal aneurysm:a speckle tracking study[J].Cardiol J,2015,22(5):535-540.
10.Wak ami K,Ohte N,A sada K,et al.Correlation bet ween lef t ventricular end-diastolic pressure and peak left atrial wall strain during left ventricular systole[J].J Am Soc Echocardiogr,2009,22(7):847-851.
11.D’Ascenzi F,Pelliccia A,Natali BM,et al.Increased left atrial size is associated with reduced atrial stiffness and preserved reservoir function in athlete’s heart[J].Int J Cardiovac Imaging,2015,31(4):699-705.
12.Ingle L,Cleland JG,Clark AL.Perception of symptoms is out of proportion to cardiac pathology in patients with“diastolic heart failure”[J].Heart,2008,94(6):748-753.
13.Dahlstr?m U.Can natriuretic peptides be used for the diagnosis of diastolic heart failure?[J].Eur J Heart Fail,2004,6(3):281-287.
14.Hoit B,Shao Y,Gabel M,et al.Left atrial systolic and diastolic function after cessation of pacing in tachycardia-induced heart failure[J].Am J Physiol,1997,273(2 Pt 2):H921-H927.
15.Kadappu KK,Thomas L.Tissue Doppler imaging in echocardiography:value and limitations[J].Heart Lung Circ,2015,24(3):224-233.
2.Tsang TS,Barnes ME,Gersh BJ,et al.Prediction of risk for first age-related cardiovascular events in an elderly population:the incremental value of echocardiography[J].J Am Coll Cardiol,2003,42(7):1199-1205.
3.Tsang TS,Barnes ME,Gersh BJ,et al.Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden[J].Am J Cardiol,2002,90(12):1284-1289.
4.Yoon YE,Kim HJ,Kim SA,et al.Left atrial mechanical function and stiffness in patients with paroxysmal atrial fibrillation[J].J Cardiovasc Ultrasound,2012,20(3):140-145.
5.X ie L,Wang Z.Cor relat ion bet ween echocard iographic lef t ventricular mass index and electrocardiographic variables used in left ventricular hypertrophy criteria in Chinese hypertensive patients[J].Hellenic J Cardiol,2010,51(5):391-401.
6.Machino-Ohtsuka T,Seo Y,Tada H,et al.Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation[J].J Cardiovasc Electrophysiol,2011,22(9):999-1006.
7.Di Salvo,Caso P,Lo Piccolo,et al.Atrial myocardial deformation proper ties predict maintenance of sinus rhy thm after external cardioversion of recent-onset lone atrial fibrillation:a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study[J].Circulation,2005,112(3):387-395.
8.Hoit BD,Walsh RA.Regional atrial distensibility[J].Am J Physiol,1992,262(5 Pt 2):H1356-H1360.
9.Demir M,Akta??,?amci S.Left atrial mechanical function and stiffness in patients with atrial septal aneurysm:a speckle tracking study[J].Cardiol J,2015,22(5):535-540.
10.Wak ami K,Ohte N,A sada K,et al.Correlation bet ween lef t ventricular end-diastolic pressure and peak left atrial wall strain during left ventricular systole[J].J Am Soc Echocardiogr,2009,22(7):847-851.
11.D’Ascenzi F,Pelliccia A,Natali BM,et al.Increased left atrial size is associated with reduced atrial stiffness and preserved reservoir function in athlete’s heart[J].Int J Cardiovac Imaging,2015,31(4):699-705.
12.Ingle L,Cleland JG,Clark AL.Perception of symptoms is out of proportion to cardiac pathology in patients with“diastolic heart failure”[J].Heart,2008,94(6):748-753.
13.Dahlstr?m U.Can natriuretic peptides be used for the diagnosis of diastolic heart failure?[J].Eur J Heart Fail,2004,6(3):281-287.
14.Hoit B,Shao Y,Gabel M,et al.Left atrial systolic and diastolic function after cessation of pacing in tachycardia-induced heart failure[J].Am J Physiol,1997,273(2 Pt 2):H921-H927.
15.Kadappu KK,Thomas L.Tissue Doppler imaging in echocardiography:value and limitations[J].Heart Lung Circ,2015,24(3):224-233.