Yamano Michiyo, Yamano Tetsuhiro, Iwamura Yumi, Nakamura Takeshi, Shiraishi Hirokazu, Shirayama Takeshi, Matoba Satoaki
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Am J Cardiol. 2017 May 15;119(10):1687-1693. doi: 10.1016/j.amjcard.2017.02.002. Epub 2017 Feb 28.
Simultaneous left atrial (LA) and left ventricular (LV) 3-dimensional (3D) echocardiographic volume measurements enable the quantifying of precise LA function, by virtue of their independence on any geometric assumption and capability of measurement for net LA conduit volume. We sought to elucidate the impact of conventional Doppler LV diastolic property on LA volume and function derived from this method. Our study subjects consisted of 381 patients who underwent 3D echocardiography. From LA time-volume curve, maximum and minimum volume index (VI) and VI before atrial contraction (LAVIpre-c) were determined; subsequently, active emptying volume was calculated as LAVIpre-c - minimum LAVI. From LA and LV volume measurement, conduit volume was calculated as LV stroke VI - (maximum LAVI - minimum LAVI). LA volume increased depending on the severity of diastolic dysfunction. Compared with patients with normal diastolic function, LA booster pump function, as the contribution of active emptying volume to LV filling, was higher in those with mild diastolic dysfunction. Additionally, it gradually decreased as diastolic dysfunction was advanced from mild to moderate and moderate to severe degree (23.2 ± 15.5%, 29.5 ± 15.1%, 25.1 ± 16.2%, 14.9 ± 14.1%, respectively; p <0.001). Contrarily, conduit contribution was significantly higher in patients with severe diastolic dysfunction than in those with mild diastolic dysfunction; furthermore, conduit function tended to increase, reciprocally to booster pump function, as diastolic dysfunction grade was advanced (39.1 ± 28.8%, 36.8 ± 26.2%, 42.7 ± 25.6%, 52.9 ± 26.2%, respectively; p = 0.034). In conclusion, simultaneous LA and LV volumetric analyses through 3D echocardiography clearly demonstrate the characteristic LA functional alterations following LA dilation caused by LV diastolic dysfunction.
同步进行左心房（LA）和左心室（LV）的三维（3D）超声心动图容积测量，由于其不依赖于任何几何假设且能够测量左心房总管道容积，从而能够精确量化左心房功能。我们试图阐明传统多普勒左心室舒张特性对通过该方法得出的左心房容积和功能的影响。我们的研究对象包括381例行3D超声心动图检查的患者。从左心房时间 - 容积曲线确定最大和最小容积指数（VI）以及心房收缩前的容积指数（LAVIpre - c）；随后，主动排空容积计算为LAVIpre - c减去最小LAVI。通过左心房和左心室容积测量，管道容积计算为左心室每搏输出量VI - （最大LAVI - 最小LAVI）。左心房容积随舒张功能障碍的严重程度而增加。与舒张功能正常的患者相比，作为主动排空容积对左心室充盈的贡献，左心房辅助泵功能在轻度舒张功能障碍患者中更高。此外，随着舒张功能障碍从轻度发展到中度以及从中度发展到重度，该功能逐渐降低（分别为23.2±15.5%、29.5±15.1%、25.1±16.2%、14.9±14.1%；p<0.001）。相反，重度舒张功能障碍患者的管道贡献明显高于轻度舒张功能障碍患者；此外，随着舒张功能障碍分级的进展，管道功能倾向于增加，与辅助泵功能呈相反变化（分别为39.1±28.8%、36.8±26.2%、42.7±25.6%、52.9±26.2%；p = 0.034）。总之，通过3D超声心动图同步进行左心房和左心室容积分析清楚地显示了由左心室舒张功能障碍引起的左心房扩张后左心房功能的特征性改变。
