二维斑点追踪成像评价阻塞型睡眠呼吸暂停综合征患者左心房功能和同步性
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摘要
目的用二维斑点追踪成像(2D-STI)评价阻塞型睡眠呼吸暂停综合征(OSAS)患者左心房(LA)功能和同步性。方法根据呼吸暂停低通气指数(AHI)将OSAS患者分为轻度、中度组和重度组各20例,对照组20例。测量收缩期和舒张晚期的LA应变和应变率(LASs、LASa、LASRs、LASRa)及应变达峰时间标准差(SDs、SDa)。结果与对照组比较,中重度组LASs和LASRs减低,LASa、LASRa和SDs增大,左房大小正常的OSAS患者LASs和LASRs减低,LASRa和SDs增大。LASs、LASRs和SDs与AHI相关。结论中重度OSAS患者LA储器功能和储器时相同步性受损,泵功能增强,并先于LA形态学改变。LA储器功能和储器时相同步性变化与OSAS严重性相关。
Objective The aim of this study was to investigate left atrial(LA)function and synchrony in obstructive sleep apnea syndrome(OSAS)patients using two-dimensional speckle tracking imaging(2D-STI).Methods 20 healthy controls were enrolled.Sixty OSAS patients were divided into mild,moderate and severe group according to apnea hypopnea index(AHI).Obtain the LA strain and strain rate at systolic and late diastolic stages(LASs,LASa,LASRs,LASRa).The standard deviation of the strain time to peak(SDs,SDa)were calculated respectively.Results Compared with the control group,LASs and LASRs were reduced,LASa and LASRa were enhanced,SDs was increased in moderate and severe group,and OSAS patients with normal LA sizes exhibited lower LASs and LASRs values and increased LASRa and SDs values.LASs、LASRs and SDs were correlated with AHI.Conclusions In moderate and severe OSAS patients,LA reservoir function and synchronism in reservoir phase was damaged,pump function was enhanced.And these changes can also be detected even in the absence of LA enlargement.LA reservoir function and synchrony changes in reservoir phase were related to the severity of OSAS.
Objective The aim of this study was to investigate left atrial(LA)function and synchrony in obstructive sleep apnea syndrome(OSAS)patients using two-dimensional speckle tracking imaging(2D-STI).Methods 20 healthy controls were enrolled.Sixty OSAS patients were divided into mild,moderate and severe group according to apnea hypopnea index(AHI).Obtain the LA strain and strain rate at systolic and late diastolic stages(LASs,LASa,LASRs,LASRa).The standard deviation of the strain time to peak(SDs,SDa)were calculated respectively.Results Compared with the control group,LASs and LASRs were reduced,LASa and LASRa were enhanced,SDs was increased in moderate and severe group,and OSAS patients with normal LA sizes exhibited lower LASs and LASRs values and increased LASRa and SDs values.LASs、LASRs and SDs were correlated with AHI.Conclusions In moderate and severe OSAS patients,LA reservoir function and synchronism in reservoir phase was damaged,pump function was enhanced.And these changes can also be detected even in the absence of LA enlargement.LA reservoir function and synchrony changes in reservoir phase were related to the severity of OSAS.
引文
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[2] GUPTA S,MATULEVICIUS S A,AYERS C R,et al.Left atrial structure and function and clinical outcomes in the general population[J].Eur Heart J,2013,34(4):278-285.
[3] RONDANO E,DELL′ERA G,DE LUCA G,et al.Left atrial asynchrony is a major predictor of 1-year recurrence of atrial fibrillation after electrical cardioversion[J].J Cardiovasc Med,2010,11(7):499-506.
[4] LANG R M,BADANO L P,MOR-AVI V,et al.Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults:An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J].Eur Heart J Cardiovasc Imaging,2016,17(4):412.
[5]石艳萍,李一丹,蔡绮哲,等.阻塞型睡眠呼吸暂停综合征患者早期左心房结构和功能改变的临床研究[J].中华超声影像学杂志,2017,26(11):934-939.
[6] BAYIR P T,DEMIRKAN B,BAYIR O,et al.Impact of Continuous Positive Airway Pressure Therapy on Atrial Electromechanical Delay and P-Wave Dispersion in Patients with Obstructive Sleep Apnea[J].Ann Noninvasive Electrocardiol,2014,19(3):226-233.
[7] RAMOS P,RUBIES C,TORRES M,et al.Atrial fibrosis in a chronic murine model of obstructive sleep apnea:mechanisms and prevention by mesenchymal stem cells[J].Respir Res,2014,28(15):54.
[8] KUPPAHALLY S S,AKOUM N,BURGON N S,et al.Left atrial strain and strain rate in patents with paroxysmal and persistent atrial fibrillation:relationship to left atrial structural remodeling detected by delayed enhancement MRI[J].Circ Cardiovasc Imaging,2010,3(3):231-239.