Hatipoglu Suzan, Ozdemir Nihal, Babur Guler Gamze, Omaygenc Mehmet Onur, Bakal Ruken Bengi, Kahveci Gokhan, Unkun Tuba, Sahin Gulsum, Kaymaz Cihangir
Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey,
Int J Cardiovasc Imaging. 2014 Oct;30(7):1315-23. doi: 10.1007/s10554-014-0476-y. Epub 2014 Jun 24.
In the absence of mitral valve disease left atrial (LA) volume is a marker of diastolic dysfunction and its severity. This study investigated the relationship between left ventricular (LV) end diastolic pressure (LVEDP) and LA volumes and phasic atrial functions detected by real-time full volume three-dimensional echocardiography (RT3DE), in a patient population with preserved LV systolic function. Seventy-two (39 female and 33 male; mean age 56.1 ± 9.0 years) stable patients with normal LV ejection fraction (EF) undergoing cardiac catheterization were studied. All patients underwent comprehensive echocardiographic examination just before catheterization and LVEDP was obtained. In addition to conventional echocardiographic measurements and Doppler indices; by using RT3DE LA maximum, minimum and pre-a-wave volumes were measured; LA total, passive and active emptying volumes and fractions were calculated. LV systolic function was assessed by EF and global longitudinal strain by speckle tracking. RT3DE minimum LA volume index, RT3DE active LAEF and LA expansion index (EI) were statistically significant univariate predictors of LVEDP ≥ 16 mmHg. When age and hypertension adjusted multivariate analysis was performed EI [β = -1.741, p = 0.015; OR 0.175; 95 % CI (0.043-0.717)] was an independent predictor of elevated LVEDP. RT3DE evaluation of LA function during entire cardiac cycle has incremental value for the diagnosis of diastolic dysfunction in patients with preserved EF. We suggest that RT3DE evaluation of LA may find clinical application in this field.
在没有二尖瓣疾病的情况下，左心房（LA）容积是舒张功能障碍及其严重程度的一个标志物。本研究在左心室（LV）收缩功能保留的患者群体中，调查了左心室舒张末期压力（LVEDP）与通过实时全容积三维超声心动图（RT3DE）检测的LA容积及心房阶段性功能之间的关系。研究了72例（39例女性和33例男性；平均年龄56.1±9.0岁）左心室射血分数（EF）正常且病情稳定、正在接受心导管检查的患者。所有患者在导管检查前均接受了全面的超声心动图检查，并获得了LVEDP。除了常规的超声心动图测量和多普勒指标外，通过使用RT3DE测量了LA最大、最小和a波前容积；计算了LA总排空容积、被动排空容积、主动排空容积及其分数。通过EF和斑点追踪法测量的整体纵向应变评估LV收缩功能。RT3DE最小LA容积指数、RT3DE主动LA射血分数（LAEF）和LA扩张指数（EI）是LVEDP≥16 mmHg的统计学显著单变量预测指标。在进行年龄和高血压校正的多变量分析时，EI[β = -1.741，p = 0.015；OR 0.175；95%CI（0.043 - 0.717）]是LVEDP升高的独立预测指标。在整个心动周期中对LA功能进行RT3DE评估，对于诊断EF保留的患者的舒张功能障碍具有增量价值。我们建议，对LA进行RT3DE评估可能在该领域找到临床应用。
