左心房容积指数及应变评价二尖瓣成形术后左心房逆向重构

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摘要目的：应用左心房容积指数和应变参数评价二尖瓣脱垂手术后左心房逆向重构。方法：选择25例拟行二尖瓣成形术的二尖瓣脱垂患者为病例组，根据左心房前后径大小分为两个亚组，左心房前后径≤45 mm的为I组（n=10），左心房前后径＞45 mm的为Ⅱ组（n=15），于术前3天、术后2周及3月应用Simpsion双平面法测量左心房最大容积（LAVmax）、最小容积（LAVmin）、收缩前容积（LAVpreA），计算术后容积变化率；应用二维斑点追踪技术测量左心房峰值应变（PALS）、舒张早期纵向应变（ALSE）、和左心房收缩峰值应变（PACS）。选择同期20例健康人作为对照组。结果：二尖瓣脱垂患者LAVmax、LAVpreA、LAVmin升高，PALS、ALSE、PACS减低；LAVmax、LAVpreA、LAVmin于术后2周和3月时均降低，但PALS、ALSE、PACS在术后2周降低，3月时升高；术前LAVImax、PALS、PACS与术后容积变化率相关。结论：术前LAVImax、PALS和PACS与术后左心房逆向重构相关。

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	焦晓芳
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	张艺
	杨军

关键词 ：心房功能, 左, 超声心动描记术, 多普勒, 彩色

Abstract：Objective: To investigate the left atrial reverse remodeling in patients with mitral valve prolapse(MVP) after mitral valve plasty with left atrial volume index and strain parameters using Simpson’s method and two-dimensional speckle tracking echocardiography(2D-STE). Methods: Twenty-five patients in sinus rhythm with MVP were classified into two groups according to the diameter of left atrium(LAD). LAD≤45 mm was defined as group Ⅰ(n=10) and LAD＞45 mm was defined as group Ⅱ(n=15). These patients undertook echocardiography respectively 3 days before, 2 weeks and 3 months after the surgery. Maximal left atrial volume(LAVmax), minimal left atrial volume(LAVmin), precontraction left atrail volume(LAVpreA), percentage change in LAVmax and left atrial volume indexed to body surface area(left atrial volume index, LAVI) were measured using Simpson’s method. Furthermore, peak atrial longitudinal strain(PALS), atrial longitudinal strain during early diastole(ALSE), and peak atrial contraction strain(PACS) were assessed using 2D-STE. Twenty healthy controls were recruited concurrently. Results: LAVmax, LAVpreA and LAVmin increased, while PALS, ALSE and PACS decreased in patients with MVP. LAVmax, LAVpreA, LAVmin decreased 2 weeks and 3 months after mitral valvuloplasty, while PALS, ALSE and PACS decreased 2 weeks after operation and increased 3 months after operation. Percentage change in LAVmax showed linear correlation with LAVI(r=0.46, P＜0.05), PALS(r=0.49, P＜0.05) and PACS(r=0.43, P＜0.05). Conclusion: LAVI and left atrial strain were correlated well with left atrial reverse remodeling after mitral valve plasty.

Key words： Atrial function, left Echocardiography, Doppler, color

收稿日期: 2017-03-16

PACS:	Ｒ540.45
	Ｒ542.51

基金资助:沈阳市科技计划项目基金（F15-199-1-32）。

通讯作者: 陈昕，中国医科大学附属第一医院心血管超声科，110001。E-mail：chen_heart@163.com

作者简介: 焦晓芳（1980-），女，辽宁人，副主任医师。E-mail：jiaoxiaofang1980@163.com

引用本文:

焦晓芳，陈昕，张婷婷，张静，张艺，杨军. 左心房容积指数及应变评价二尖瓣成形术后左心房逆向重构[J]. 中国临床医学影像杂志, 2018, 29(1): 14-17.
JIAO Xiao-fang, CHEN Xin, ZHANG Ting-ting, ZHANG Jing, ZHANG Yi, YANG Jun. Assessment of left atrial reverse remodeling after mitral valve plasty by left atrial volume index and strain. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(1): 14-17.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2018/V29/I1/14

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