左心室构型对阻塞性睡眠呼吸暂停综合征左心房时相功能的影响：一项多模态超声心动图研究。
The impact of left ventricular geometry on left atrium phasic function in obstructive sleep apnea syndrome: a multimodal echocardiography investigation.
机构信息
Medical imaging department of Shanxi Medical University; Department of Ultrasound, First Hospital of Shanxi Medical University, 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi, China.
Department of Respiratory, First Hospital of Shanxi Medical University, 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi, China.
出版信息
BMC Cardiovasc Disord. 2021 Apr 24;21(1):209. doi: 10.1186/s12872-021-02018-1.
BACKGROUND
Left ventricular geometry and left atrium (LA) enlargement are risk factors for cardiovascular disease. However, reports on the relationship between left ventricular geometry and LA volume yielded contradictory findings, and LA phasic function remains unclear. Hence, this study aimed to investigate the influence of left ventricular geometry on LA volume and phasic function in patients with obstructive sleep apnea syndrome (OSAS) via a multimodal echocardiographic approach.
METHODS
In this cross-sectional study, 221 patients with OSAS (age 20-68 years, mean age 45.27 ± 12.50 years) underwent clinical evaluation, polysomnography, and multimodal echocardiographic examination with two-dimensional echocardiography (2DE), two-dimensional speckle-tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE). Based on conventional classification of left ventricular geometry, patients with OSAS were divided into four groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH).
RESULTS
Based on 2DE and 3DE, the LA volumes and indices gradually increased from NG to CH. Additionally, 2DE and 3DE LA maximum volume index (LAVImax) were higher in patients with CH and EH than in patients with NG and CR (P < 0.05). The reservoir function, estimated by LA total emptying fraction (LA TotEF) was lower in patients with CH than in patients with NG in 2DE and 3DE (both, P < 0.05). Also, LA conduit function, evaluated by LA passive emptying fraction (LA PassEF) was lower in patients with CH than in patients with NG and CR, and in patients with EH than in those with NG in 2DE and 3DE (all, P < 0.05). The LA booster pump function, evaluated by LA active emptying fraction (LA ActEF) showed no statistically significant difference in 2DE; however, it was greater in patients with CH than in those with NG in 3DE. Similar results were obtained by 2D-STE, and CH was significantly associated with LA strain during systole (LAS-S, β = - 0.546, 95%CI: - 6.371-(- 3.444); P < 0.001), early diastole (LAS-E, β = - 0.636, 95%CI: - 9.532-(- 5.710); P < 0.001), and late diastole (LAS-A, β = - 0.450, 95%CI: 1.518-3.909; P < 0.001) in multiple linear regression.
CONCLUSIONS
The LA phasic function changed with left ventricular geometry via multimodal echocardiography. CH had the most notable negative effect on the maximum volume and phasic function of the LA.
背景
左心室几何形状和左心房（LA）增大是心血管疾病的危险因素。然而，关于左心室几何形状与 LA 容积之间关系的报告得出了相互矛盾的结果，LA 时相功能仍不清楚。因此，本研究旨在通过多模态超声心动图研究阻塞性睡眠呼吸暂停综合征（OSAS）患者左心室几何形状对 LA 容积和时相功能的影响。
方法
在这项横断面研究中，221 例 OSAS 患者（年龄 20-68 岁，平均年龄 45.27±12.50 岁）接受了临床评估、多导睡眠图和多模态超声心动图检查，包括二维超声心动图（2DE）、二维斑点追踪超声心动图（2D-STE）和三维超声心动图（3DE）。根据左心室几何形状的常规分类，将 OSAS 患者分为四组：正常几何形状（NG）、同心重构（CR）、同心肥厚（CH）和偏心肥厚（EH）。
结果
基于 2DE 和 3DE，LA 容积和指数从 NG 逐渐增加到 CH。此外，与 NG 和 CR 组相比，CH 和 EH 组的 2DE 和 3DE 的 LA 最大容积指数（LAVImax）更高（均 P<0.05）。与 NG 组相比，CH 组的 2DE 和 3DE 的 LA 总排空分数（LA TotEF）的储存功能（由 LA 总排空分数评估）更低（均 P<0.05）。此外，与 NG 和 CR 组相比，CH 组的 LA 被动排空分数（LA PassEF）评估的 LA 导管功能更低，与 NG 组相比，EH 组的 LA PassEF 更低，与 NG 组相比，EH 组的 LA PassEF 更低，在 2DE 和 3DE 中均如此（均 P<0.05）。由 LA 主动排空分数（LA ActEF）评估的 LA 助推泵功能在 2DE 中没有统计学意义上的差异；然而，在 3DE 中，CH 组的 LA ActEF 大于 NG 组。2D-STE 也得到了类似的结果，CH 与收缩期 LA 应变（LAS-S，β=-0.546，95%CI：-6.371-（-3.444）；P<0.001）、早期舒张期 LA 应变（LAS-E，β=-0.636，95%CI：-9.532-（-5.710）；P<0.001）和晚期舒张期 LA 应变（LAS-A，β=-0.450，95%CI：1.518-3.909；P<0.001）显著相关。
结论
LA 时相功能通过多模态超声心动图随左心室几何形状而变化。CH 对 LA 最大容积和时相功能的负面影响最为显著。
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