Fang Hui, Tang Hailin, Li Peng, Xiong Li, Hu Gongpai, Li Li, Yu Yonghong, Zhao Bowen
Department of Diagnostic Ultrasound and Echocardiography, Tongde Hospital of Zhejiang Province, Hangzhou, China.
Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China.
Echocardiography. 2017 Mar;34(3):407-414. doi: 10.1111/echo.13460. Epub 2017 Jan 28.
The objective of this study was to assess left atrial (LA) function with two-dimensional speckle tracking echocardiography (2DSTE) in addition to standard echocardiographic assessments in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and 1 year after septal ablation (SA).
The study included 31 patients with HOCM, who underwent SA. Each patient with HOCM underwent a complete two-dimensional transthoracic echocardiography before and 1 year after the SA. The measurements included basal septal thickness, left ventricular outflow trace (LVOT) gradient, mitral regurgitation (MR) grade, LA dimensions, left ventricular (LV) ejection fraction, and tissue Doppler parameters of lateral mitral annular e' and septal mitral annular e'. The LA wall was tracked on a frame-by-frame basis using 2DSTE, and LA volume waveforms were generated. The maximum LA volume (LAV ), minimal LA volume (LAV ), and the LA volume before atrial contraction (LAV ) were measured. The LA reservoir function was calculated as the expansion index and diastolic emptying index. The LA conduit function was calculated as the passive emptying percentage of total emptying (PE) and the passive emptying index (PEI). The LA booster function was calculated as the active emptying percentage of total emptying (AE) and the active emptying index (AEI).
The LVOT gradient, end-diastolic septal base thickness, the grade of MR, and LA end-diastolic size were significantly decreased in patients with HOCM before and 1 year after the SA (All P<.05). The lateral mitral annular e' was significantly increased (P<.05), and the E/lateral e' ratio was significantly decreased (P<.05), whereas septal mitral annular e' was significantly decreased (P<.05), and the E/septal e' ratio was significantly increased (P<.05). LAVI , LAVI , and LAVI were significantly decreased 1 year after the SA (All P<.05). The expansion and diastolic emptying indices were significantly increased (All P<.05) at 1 year after the SA. PE and PEI were significantly increased (All P<.05). The AE and AEI were significantly decreased (All P<.05). LAVI , LAVI , and LAVI of the responders group were significantly lower than those of the nonresponders group (All P<.05). The expansion and diastolic emptying indices of the responders group were significantly higher than those of the nonresponders group (All P<.05). The PE and PEI of the responders were significantly higher than those of the nonresponders group (All P<.05). The AE and AEI of the responders were significantly lower than those of the nonresponders group (All P<.05).
We found an improvement in the LA reservoir and conduit function but a reduction in LA booster pump function 1 year after the SA in the responders.
本研究的目的是在肥厚性梗阻性心肌病（HOCM）患者行室间隔消融术（SA）前及术后1年，除进行标准超声心动图评估外，还使用二维斑点追踪超声心动图（2DSTE）评估左心房（LA）功能。
本研究纳入31例行SA的HOCM患者。每位HOCM患者在SA前及术后1年均接受完整的二维经胸超声心动图检查。测量指标包括室间隔基底厚度、左心室流出道（LVOT）梯度、二尖瓣反流（MR）分级、LA大小、左心室（LV）射血分数以及二尖瓣外侧环e'和二尖瓣间隔环e'的组织多普勒参数。使用2DSTE逐帧追踪LA壁，并生成LA容积波形。测量最大LA容积（LAV）、最小LA容积（LAV）和心房收缩前的LA容积（LAV）。LA储存功能计算为扩张指数和舒张期排空指数。LA管道功能计算为总排空的被动排空百分比（PE）和被动排空指数（PEI）。LA助力泵功能计算为总排空的主动排空百分比（AE）和主动排空指数（AEI）。
HOCM患者在SA前及术后1年，LVOT梯度、舒张末期室间隔基底厚度、MR分级和LA舒张末期大小均显著降低（所有P<0.05）。二尖瓣外侧环e'显著增加（P<0.05），E/外侧e'比值显著降低（P<0.05），而二尖瓣间隔环e'显著降低（P<0.05），E/间隔e'比值显著增加（P<0.05）。SA术后1年，LAVI、LAVI和LAVI显著降低（所有P<0.05）。SA术后1年，扩张和舒张期排空指数显著增加（所有P<0.05）。PE和PEI显著增加（所有P<0.05）。AE和AEI显著降低（所有P<0.05）。反应者组的LAVI、LAVI和LAVI显著低于无反应者组（所有P<0.05）。反应者组的扩张和舒张期排空指数显著高于无反应者组（所有P<0.05）。反应者的PE和PEI显著高于无反应者组（所有P<0.05）。反应者的AE和AEI显著低于无反应者组（所有P<0.05）。
我们发现，对于反应者，SA术后1年LA储存和管道功能有所改善，但LA助力泵功能降低。
