超声心动图评估心尖肥厚型心肌病左心房结构与功能的临床价值分析

Clinical Value Analysis of Echocardiographic Evaluation of Left Atrial Structure and Function in Apical Hypertrophic Cardiomyopathy

摘要: 目的：利用实时三维超声心动图(RT-3DE)联合二维斑点追踪技术(2D-STI)对心尖肥厚型心肌病(AHCM)患者的左心房结构与功能进行全面评估，并探讨这些变化与临床指标的相关性。通过对比AHCM患者与健康对照组的差异，为AHCM的临床诊断、治疗及预后评估提供新的依据。方法：本研究纳入了2022年1月至2024年1月在XX医院接受治疗的150例AHCM患者作为研究组，同时选择同期在该医院接受体检的150例健康人作为对照组。研究采用飞利浦EPIQ 7C高端彩色多普勒超声诊断系统，结合S5-1及X5-1型号的二维与三维经胸超声探头，对研究对象进行超声检查。通过RT-3DE技术测量左心房的容积参数，包括最大左心房容积(LAVmax)、最小左心房容积(LAVmin)等，并通过2D-STI技术评估左心房的心肌应变率参数，如左房储器期应变(LASr)、左房管道应变(LAScd)等。同时，收集研究对象的年龄、性别、体表面积(BSA)、血压、体重指数(BMI)等一般资料，并进行血常规、生化指标等实验室检测。采用SPSS 23.0软件进行统计分析，比较两组间的差异，并探讨相关性。结果：AHCM组患者的年龄显著高于对照组(P < 0.001)，心率(HR)也显著升高(P < 0.001)。在左心房结构方面，AHCM组患者的左心房直径(LAD)、左心房长度(LAL)、左心房厚度(LAT)、LAVmax、LAVmin及左心房容积指数(LAVI)均显著大于对照组(P均<0.05)。在左心房功能方面，AHCM组患者的左心房射血分数(LAEF)、左心房被动排空分数(LAPEF)及左心房主动排空分数(LAAEF)均显著低于对照组(P均<0.05)，而左心房收缩容积(LASV)则显著增加(P < 0.001)。此外，AHCM组患者的LASr和LAScd显著高于对照组(P < 0.05)，左心房峰值储备应变率(pLASRr)和左心房收缩期峰值应变率(pLASRcd)的绝对值也显著高于对照组(P < 0.05)。相关性分析显示，LAEF与pLASRc和pLASRcd呈正相关(P < 0.001)，LAAEF与pLASRr和pLASRcd呈正相关(P < 0.001)，而LAPEF与pLASRc和pLASRr呈正相关(P < 0.001)。亚组分析显示，NYHA III~IV级患者的左心房功能参数显著低于NYHA I~II级患者(P均<0.05)，且心肌应变率参数存在显著差异(P < 0.05)。重复性检验结果显示，LAEF和pLASRct的测量结果具有良好的重复性(P均>0.05)。结论：AHCM患者左心房的结构与功能均发生了显著变化，具体表现为左心房容积增大、形态异常以及功能减退等。同时，心肌应变率参数与左心房功能指标之间存在显著相关性，提示心肌应变率参数可用于评估AHCM患者左心房功能的改变。这些发现不仅丰富了对AHCM病理生理机制的认识，也为临床诊断和治疗提供了新的视角和依据。未来研究可进一步探讨AHCM患者左心房结构与功能变化的机制及其与临床预后的关系，为制定更加精准的治疗方案提供科学依据。

Abstract: Objective: To comprehensively assess the structural and functional changes of the left atrium in patients with apical hypertrophic cardiomyopathy (AHCM) using real-time three-dimensional echocardiography (RT-3DE) combined with two-dimensional speckle tracking imaging (2D-STI), and to explore the correlations between these changes and clinical indicators. By comparing the differences between AHCM patients and healthy controls, this study aims to provide new evidence for the clinical diagnosis, treatment, and prognosis assessment of AHCM. Methods: This study enrolled 150 AHCM patients treated at XX Hospital from January 2022 to January 2024 as the study group, and 150 healthy individuals who underwent physical examinations at the same hospital during the same period as the control group. The Philips EPIQ 7C premium color Doppler ultrasound diagnostic system, equipped with S5-1 and X5-1 two-dimensional and three-dimensional transthoracic ultrasound probes, was used to perform ultrasound examinations on the study subjects. RT-3DE technology was employed to measure left atrial volume parameters, including maximum left atrial volume (LAVmax) and minimum left atrial volume (LAVmin). Meanwhile, 2D-STI technology was utilized to assess left atrial myocardial strain rate parameters, such as left atrial reservoir strain (LASr) and left atrial conduit strain (LAScd). Additionally, general information, including age, gender, body surface area (BSA), blood pressure, and body mass index (BMI), was collected, and laboratory tests for blood routine and biochemical indicators were conducted. Statistical analysis was performed using SPSS 23.0 software to compare differences between the two groups and explore correlations. Results: Patients in the AHCM group had significantly higher age (P < 0.001) and heart rate (HR) (P < 0.001) compared to the control group. In terms of left atrial structure, the left atrial diameter (LAD), left atrial length (LAL), left atrial thickness (LAT), LAVmax, LAVmin, and left atrial volume index (LAVI) were significantly greater in the AHCM group than in the control group (all P < 0.05). Regarding left atrial function, the left atrial ejection fraction (LAEF), left atrial passive emptying fraction (LAPEF), and left atrial active emptying fraction (LAAEF) were significantly lower in the AHCM group than in the control group (all P < 0.05), while the left atrial systolic volume (LASV) was significantly increased (P < 0.001). Furthermore, the LASr and LAScd were significantly higher in the AHCM group than in the control group (P < 0.05), and the absolute values of peak left atrial reservoir strain rate (pLASRr) and peak left atrial contraction strain rate (pLASRcd) were also significantly higher in the AHCM group (P < 0.05). Correlation analysis revealed positive correlations between LAEF and pLASRc, pLASRcd (both P < 0.001), between LAAEF and pLASRr, pLASRcd (both P < 0.001), and between LAPEF and pLASRc, pLASRr (both P < 0.001). Subgroup analysis showed that left atrial functional parameters were significantly lower in NYHA III~IV patients compared to NYHA I~II patients (all P < 0.05), with significant differences in myocardial strain rate parameters (P < 0.05). Reproducibility test results indicated good repeatability for the measurements of LAEF and pLASRc (both P > 0.05). Conclusion: Significant changes have occurred in the structure and function of the left atrium in AHCM patients, manifested as increased left atrial volume, morphological abnormalities, and functional impairment. Meanwhile, there is a significant correlation between myocardial strain rate parameters and left atrial functional indicators, suggesting that myocardial strain rate parameters can be used to assess left atrial function in AHCM patients. These findings not only enrich our understanding of the pathophysiological mechanisms of AHCM but also provide new perspectives and evidence for clinical diagnosis and treatment. Future studies can further explore the mechanisms underlying the structural and functional changes of the left atrium in AHCM patients and their relationship with clinical prognosis, providing a scientific basis for developing more precise treatment plans.