左心房(LA)大小在临床实践中经常被用作LA功能的替代标记,较大的心房被认为代表“功能障碍”心房,因为没有公认的“黄金”标准来评估LA功能。LA大小与相位功能之间的确切关系,以及在LA扩大(LAE)之前是否发生LA功能障碍可能具有临床意义,但尚未得到充分研究。二维斑点追踪超声心动图(2DSTE)是测量LA物理变形的一种有前途的方法。
715名心血管疾病高危患者的社区队列接受了综合超声心动图检查。LA纵向相位应变Sa(心房收缩期间的绝对峰值应变),Se(舒张早期的峰值应变)和Stot(总心房应变=SaSe),代表收缩,导管,和储层功能,在根尖4腔视图中使用离线2DSTE软件进行测量,并比较不同LA大小的组间和正常LA大小有无高血压(HT)的亚组之间的数据.
使用LAE(从正常尺寸,温和,中度至重度LAE),Stot(分别为21.74±5.97、20.75±4.99、20.49±5.27、17.75±4.71,方差分析P=0.003)和Sa(分别为11.84±3.92,11.00±3.29,10.11±2.57,8.55±2.88,方差分析P<0.001)降低,硒无变化。重度LAE组的Stt显著低于正常LA大小组(P=0.002)。三个LAE组的Sa均显著低于正常LA大小组(P=0.024,P=0.002,P<0.001)。在正常大小的LA亚组中,Stot(21.35±5.91vs.23.01±6.02,P=0.008)和Se(9.51±4.41vs.与没有HT的受试者相比,有HT的受试者降低了11.17±4.89,P<0.001)。
LA阶段性功能重塑发生在LAE之前,并继续LAE,与水库,导管和收缩功能受到无与伦比的影响。
Left atrial (LA) size is often used as a surrogate marker of LA function in clinical practice, with larger atrial thought to represent a \"dysfunctioning\" atrium, since there is no accepted \'gold\' standard to evaluate LA function. The exact relationship between LA size and phasic function, and whether LA dysfunction occur before LA enlargement (LAE) may be of clinical interest while have not been fully studied. Two-dimensional speckle-tracking echocardiography (2D STE) was showed a promising method in measuring LA physical deformation.
A community cohort of 715 subjects at cardiovascular disease high risk accepted comprehensive echocardiography. LA longitudinal phasic strain Sa (absolute peak strain during atrial contraction), Se (peak strain at early diastole) and Stot (total atrial strain = Sa + Se), representing contractile, conduit, and reservoir function respectively, were measured using off-line 2D STE software in apical 4 chamber view, and data were compared among groups at different LA size and between subgroups in normal LA size with and without hypertension (HT).
With LAE (from normal size, mild, moderate to severe LAE), the Stot (21.74 ± 5.97, 20.75 ± 4.99, 20.49 ± 5.27, 17.75 ± 4.71, respectively, ANOVA P = 0.003) and Sa (11.84 ± 3.92, 11.00 ± 3.29, 10.11 ± 2.57, 8.55 ± 2.88, respectively, ANOVA P < 0.001) reduced while Se had no change. Stot of Severe LAE group was significantly lower than that of Normal LA size group (P = 0.002). Sa of the three LAE groups were all significantly lower than that of Normal LA size group (P = 0.024, P = 0.002, P < 0.001, respectively). In normal sized LA subgroups, Stot (21.35 ± 5.91 vs. 23.01 ± 6.02, P = 0.008) and Se (9.51 ± 4.41 vs. 11.17 ± 4.89, P < 0.001) reduced in subjects with HT comparing with those without.
LA phasic function remodeling occurs before LAE and continues with LAE, with reservoir, conduit and contractile function being affected unparalleled.