切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2021, Vol. 18 ›› Issue (12) : 1158 -1163. doi: 10.3877/cma.j.issn.1672-6448.2021.12.007

心血管超声影像学

二维斑点追踪成像与三维容积成像对左心房时相功能的评价比较
徐丽娜1, 吕秀章1,†(), 李一丹1, 孙兰兰1, 朱维维1, 丁雪晏1, 张淼1   
  1. 1. 100020　首都医科大学附属北京朝阳医院心脏超声科
  • 收稿日期:2021-05-16 出版日期:2021-12-01
  • 通信作者: 吕秀章
  • 基金资助:
    北京市医管局青年人才培养“青苗”计划(QML20180302); 北京市医院管理局临床技术创新项目(XMLX201827)

Evaluation of phasic function of left atrium by two-dimensional speckle tracing imaging and three-dimensional volumetric imaging

Lina Xu1, Xiuzhang Lyu1,†(), Yidan Li1, Lanlan Sun1, Weiwei Zhu1, Xueyan Ding1, Miao Zhang1   

  1. 1. Department of Echocardiography, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2021-05-16 Published:2021-12-01
  • Corresponding author: Xiuzhang Lyu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

徐丽娜, 吕秀章, 李一丹, 孙兰兰, 朱维维, 丁雪晏, 张淼. 二维斑点追踪成像与三维容积成像对左心房时相功能的评价比较[J/OL]. 中华医学超声杂志（电子版）, 2021, 18(12): 1158-1163.

Lina Xu, Xiuzhang Lyu, Yidan Li, Lanlan Sun, Weiwei Zhu, Xueyan Ding, Miao Zhang. Evaluation of phasic function of left atrium by two-dimensional speckle tracing imaging and three-dimensional volumetric imaging[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(12): 1158-1163.

目的

应用二维斑点追踪成像（2D-STI）技术定量评价左心房（LA）时相功能，并与三维容积（3D-EV）评价进行对比研究。

方法

选取2018年10月至2019年10月于首都医科大学附属北京朝阳医院接受经胸超声心动图检查诊断为LA增大的患者89例，根据左心房最大容积指数（LAVImax）将其分为LA轻度增大组41例、LA中度增大组27例和LA重度增大组21例。另选取LA大小正常者29例。应用3D-EV获取左心房储器功能（LARS）、左心房管道功能（LACD）、左心房泵功能（LACT）；2D-STI获取左心房储器应变（LASr）、左心房管道应变（LAScd）、左心房收缩应变（LASct）。

结果

LARS、LACD和LACT均与LAVImax呈负相关（r=-0.772、-0.645、-0.735，P均＜0.01）。LARS、LACD和LACT在4组间比较，差异均有统计学意义（P均＜0.01）。进一步两两比较，LA大小正常组与LA轻度增大组、LA中度增大组与LA重度增大组的LARS（P=0.078、0.101）、LACD（P=0.112、0.483）、LACT（P =0.299、0.066）差异均无统计学意义。LASr、LAScd、LASct均与LAVImax呈负相关（r=-0.797、-0.703、-0.698，P均＜0.01）。LASr、LAScd、LASct在4组间比较，差异均有统计学意义（P均＜0.001）。进一步两两比较，LASr和LASct在4组间两两比较，差异均有统计学意义（P均＜0.05）；LAScd在LA大小正常组分别与LA轻度增大组、LA中度增大组、LA重度增大组比较，以及LA轻度增大组与LA重度增大组比较时，差异均有统计学意义（P均＜0.05）。

结论

2D-STI及3D-EV评价均显示LA时相功能随LA增大而减小。2D-STI可更早期发现LA时相功能异常，其可能比3D-EV评估LA时相功能更敏感。

关键词: 超声心动描记术, 二维斑点追踪成像, 三维容积, 左心房功能
Objective

To quantitatively evaluate the left atrial (LA) phasic function by two-dimensional speckle tracing imaging (2D-STI) and three-dimensional volume (3D-EV).

Methods

A total of 118 patients were selected, including 89 patients diagnosed with LA enlargement by chest echocardiography at Beijing Chaoyang Hospital Affiliated to Capital Medical University from October 2018 to October 2019, and 29 patients with normal LA size. According to the left atrial maximum volume index (LAVImax), the patients were divided into a normal LA group (29 cases), a slightly increased LA group (41 cases), a moderately increased LA group (27 cases), and a severely increased LA group (21 cases). Left atrial storage function (LARS), left atrial duct function (LACD), and left atrial pump function (LACT) were obtained by 3D-EV. Left atrial storage strain (LASr), left atrial duct strain (LAScd), and left atrial systolic strain (LASct) were obtained using 2D-STI.

Results

LARS, LACD, and LACT were negatively correlated with LAVImax (r=-0.772, -0.645, and -0.735, respectively; P＜0.01). LARS, LACD, and LACT differed significantly among the four groups (P＜0.01 for all) .Further pair-wise comparison showed that there were no significant differences in LARS (P=0.078, 0.101), LACD (P=0.112, 0.483), or LACT (P=0.299, 0.066) between the normal LA size group and the slightly increased LA group, and between the moderately increased LA group and the severely increased LA group. LASr, LAScd, and LASct were negatively correlated with LAVImax (r=-0.797, -0.703, and -0.698, respectively; P＜0.01). Further pairwise comparison showed that there were statistically significant differences in LASr and LASct between the four groups (P＜0.05 for all). There were statistically significant differences in LAScd between the normal LA size group and the slightly increased LA group, the moderately increased LA group, and the severely increased LA group, as well as between the slightly increased LA group and the severely increased LA group (P＜0.05 for all).

Conclusion

Both 2D-STI and 3D-EV evaluations showed that the time phase function of the LA decreases with the increase of LA. 2D-STI can detect abnormal LA phase function earlier and may be more sensitive than 3D-EV in evaluating LA phase function.

Key words: Echocardiography, Two-dimensional speckle tracking imaging, Three-dimensional echocardiography volume, Left atrial function
图1 左心房三维容积曲线超声图像。图示测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）、左心房A波前容积（LAVpreA）
图2 左心房整体长轴应变曲线（采用R-R间期）超声图像。图示测量正向峰值应变值、A波前应变值
表1 4组受试者一般资料及常规超声参数特征比较（
xˉ
±s）
组别 例数 年龄 性别（男/女，例） E/e' BSA（m2） LVEF（%）
LA大小正常组 29 51.9±13.3 17/12 9.9±2.9 1.86±0.16 67.3±8.5
LA轻度增大组 41 58.6±13.5 23/18 14.2±3.9 1.78±0.16 61.6±11.8
LA中度增大组 27 61.2±12.1 14/13 14.9±5.8 1.81±0.21 64.1±10.9
LA重度增大组 21 68.5±12.4 11/10 15.5±5.1 1.74±0.16 58.4±15.2
统计值 F=6.9 χ2=0.34 F=8.8 F=2.1 F=2.7
P值 ＜0.01 0.952 ＜0.01 0.107 0.048
表2 4组受试者左心房时相功能参数特征比较（%，
xˉ
±s）
组别 例数 LARS LACD LACT LASr LAScd LASct
LA大小正常组 29 60.6±7.3ab 26.1±7.1 ab 46.7±8.1 ab 38.2±7.6 abc 20.3±6.1 abc 17.9±5.8 abc
LA轻度增大组 41 52.5±10.0 ab 21.1±6.4 ab 40.1±10.4 ab 25.7±7.4 ab 12.6±5.1a 13.1±4.2 ab
LA中度增大组 27 39.0±9.5 15.4±6.0 28.2±7.9 19.1±5.8 a 9.6±4.0 9.5±3.3 a
LA重度增大组 21 27.3±7.7 11.4±5.5 18.1±5.5 10.7±5.2 6.0±3.1 4.7±3.3
F值 F=68.6 F=26.2 F=55.4 F=74.4 F=40.2 F=41.4
P值 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01
表3 2D-STI评价的左心房时相功能参数的重复性分析
参数 观察者内 观察者间
ICC 95%CI P值 ICC 95%CI P值
LASr 0.985 0.962~0.994 ＜0.01 0.916 0.540~0.974 ＜0.01
LAScd 0.966 0.904~0.987 ＜0.01 0.891 0.466~0.966 ＜0.01
LASct 0.921 0.804~0.968 ＜0.01 0.867 0.663~0.947 ＜0.01
1
Lang RM, Badano LP, 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, 2015, 16(3): 233-270.
2
Thomas L, Marwick TH, Popescu BA, et al. Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art review [J]. J Am Coll Cardiol, 2019, 73(15): 1961-1977.
3
Dereli S, Bayramoğlu A, Özer N, et al. Evaluation of left atrial volume and function by real time three-dimensional echocardiography in anemic patients without overt heart disease before and after anemia correction [J]. Int J Cardiovasc Imaging, 2019, 35(9): 1619-1626.
4
Boyd AC, Thomasa L. Left atrial volumes: two-dimensional, three-dimensional, cardiac magnetic resonance and computed tomography measurements [J]. Curr Opin Cardiol, 2014, 29(5): 408-416.
5
van Grootel RWJ, Strachinaru M, Menting ME, et al. In-depth echocardiographic analysis of left atrial functionin healthy adults using speckle tracking echocardiography and volumetric analysis [J]. Echocardiography, 2018, 35(12): 1956-1965.
6
Le Tourneau T, Messika-Zeitoun D, Russo A, et al. Impact of left atrial volume on clinical outcome in organic mitral regurgitation [J]. J Am Coll Cardiol, 2010, 56(7): 570-578.
7
Todaro MC, Choudhuri I, Belohlavek M, et al. New echocardiographic techniques for evaluation of left atrial mechanics [J]. Eur Heart J Cardiovasc Imaging, 2012, 13(12): 973-984.
8
Nakanishi K, Jin Z, Russo C, et al. Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study [J]. Eur J Prev Cardiol, 2017, 24(4): 392-398.
9
Cameli M, Lisi M, Focardi M, et al. Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes [J]. Am J Cardiol, 2012, 110(2): 264-269.
10
Aktürk E, Yağmur J, Kurtoğlu E, et al. Left atrial volume and function in patients with Behcet's disease assessed by real-time three-dimensional echocardiography [J]. Eur Heart J Cardiovas Imaging, 2012, 13(8): 650-655.
11
Menting ME, McGhie JS, Koopman LP, et al. Normal myocardial strain values using 2D speckle tracking echocardiography in healthy adults aged 20 to 72 years [J]. Echocardiography, 2016, 33(11): 1665-1675.
[1] 杜祖升, 赵博文, 张帧, 潘美, 彭晓慧, 陈冉, 毛彦恺. 应用二维斑点追踪成像技术评估孕周及心尖方向对中晚孕期正常胎儿左心房应变的影响[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(09): 843-851.
[2] 张商迪, 赵博文, 潘美, 彭晓慧, 陈冉, 毛彦恺, 陈阳, 袁华, 陈燕. 中晚孕期胎儿心房内径定量评估心房比例失调胎儿心脏畸形的价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(08): 785-793.
[3] 王水清, 赵博文, 潘美, 彭晓慧, 陈冉, 马明明, 狄敏. 16~40周正常胎儿左心房后间隙指数及其Z评分的定量研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(05): 460-469.
[4] 李文秀, 杨爽, 吴江, 耿斌, 苏俊武. 二维经胸超声心动图诊断小儿二尖瓣裂的价值[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(11): 1186-1192.
[5] 张婉微, 秦芸芸, 蔡绮哲, 林明明, 田润雨, 金姗, 吕秀章. 心肌收缩早期延长对非ST段抬高型急性冠脉综合征患者冠状动脉严重狭窄的预测价值[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(10): 1016-1022.
[6] 任书堂, 刘晓程, 张亚东, 孙佳英, 陈萍, 周建华, 龙进, 黄云洲. 左心室辅助装置支持下单纯收缩期主动脉瓣反流的超声心动图特征[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(10): 1023-1028.
[7] 刘丹妮, 敖梦, 冉海涛, 李世玉, 秦芳. 三维超声心动图及二维斑点追踪成像对持续性心房颤动复律后双心房逆向重构的评估[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(08): 827-835.
[8] 孙佳英, 黄云洲, 任书堂, 王翠华, 陈新华, 于艾嘉, 陈元禄. 无创心肌做功对左束支传导阻滞患者左心室整体及节段心肌收缩功能的评价[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(08): 836-843.
[9] 钟露, 曹省, 宋宏宁, 陈金玲, 周青. 超声心动图定量评估二尖瓣反流程度的质量控制[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(07): 705-711.
[10] 金姗, 丁雪晏, 蔡绮哲, 李一丹, 赵智玲, 郭兮恒, 吕秀章. 左心室压力-应变环对阻塞型睡眠呼吸暂停综合征患者心肌功能的评价[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(06): 575-580.
[11] 陈丹丹, 马小静, 夏娟, 余正春, 谢姝瑞, 程冠, 吴梅. 二维斑点追踪成像技术对肥厚型心肌病患者右心室功能的评价[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(04): 417-423.
[12] 田权秀, 韩爱民, 徐艳. 动脉导管未闭与极低出生体重早产儿支气管肺发育不良的相关性分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(06): 675-682.
[13] 储慧民, 杜先锋. 心腔内超声心动图指导左心耳封堵的规范化标准流程[J/OL]. 中华心脏与心律电子杂志, 2024, 12(01): 1-5.
[14] 储慧民. 心腔内超声心动图指导下的左心耳封堵术标准流程解析[J/OL]. 中华心脏与心律电子杂志, 2024, 12(01): 58-58.
[15] 李燕伟, 黄大军, 伍洲, 张嬿, 康彧, 孔令秋. 曲折的右心声学造影一例[J/OL]. 中华心脏与心律电子杂志, 2023, 11(03): 179-181.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号