Cheung Yiu-Fai, So Edwina Kam-Fung, Hwang Gloria Yu-Yan, Chan Godfrey Chi-Fung, Ha Shau-Yin
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Pediatr Cardiol. 2019 Jun;40(5):1001-1008. doi: 10.1007/s00246-019-02105-3. Epub 2019 Apr 10.
This study aimed to assess left (LA) and right atrial (RA) function in patients with beta-thalassaemia major. Thirty-eight patients (19 males) aged 34.5 ± 10.7 years and 43 (18 males) controls aged 30.3 ± 12.6 years (p = 0.12) were studied. The maximum RA and LA areas were measured using two-dimensional planimetry, while atrial and ventricular strain and strain rates were quantified using speckle-tracking echocardiography. Compared with controls, patients had significantly reduced LA and RA peak positive strain and total strain, and LA strain rate during ventricular systole and at atrial contraction (all p < 0.05). The LA and RA strain parameters were significantly associated (all p < 0.05). The maximum LA (10.2 ± 1.6 cm/m vs. 8.6 ± 1.3 cm/m, p < 0.001) and RA (9.2 ± 1.2 cm/m vs. 7.5 ± 1.3 cm/m, p < 0.001) areas were significantly greater in patients than controls. The LV and RV strain and early strain rates were similar between patients and controls (all p > 0.05). Four patients with significant myocardial iron overload had larger LA area (p < 0.001) than those without. Functional and structural remodeling of both the right and left atria occurs in patients with beta-thalassaemia major, even in the absence of ventricular diastolic dysfunction.
本研究旨在评估重型β地中海贫血患者的左心房（LA）和右心房（RA）功能。研究对象为38例患者（19例男性），年龄34.5±10.7岁，以及43例对照者（18例男性），年龄30.3±12.6岁（p = 0.12）。采用二维平面测量法测量RA和LA的最大面积，同时使用斑点追踪超声心动图对心房和心室应变及应变率进行量化。与对照组相比，患者的LA和RA峰值正向应变及总应变显著降低，心室收缩期和心房收缩期的LA应变率也显著降低（均p<0.05）。LA和RA应变参数显著相关（均p<0.05）。患者的LA最大面积（10.2±1.6cm/m对8.6±1.3cm/m，p<0.001）和RA最大面积（9.2±1.2cm/m对7.5±1.3cm/m，p<0.001）显著大于对照组。患者与对照组之间的左心室（LV）和右心室（RV）应变及早期应变率相似（均p>0.05）。4例心肌铁过载严重的患者的LA面积大于无心肌铁过载的患者（p<0.001）。重型β地中海贫血患者即使在没有心室舒张功能障碍的情况下，左、右心房也会发生功能和结构重塑。
