超声评价创伤性多器官功能障碍患者左心房功能的研究

黄鑫; 曹剑; 刘源; 田璠; 于焱; 马宇飞; 杨明艳; 王黎; 罗渝昆; 邓玉姣

doi:10.3969/j.issn.2095-5227.2023.02.007

超声评价创伤性多器官功能障碍患者左心房功能的研究

Quantitative evaluation of left atrial function in traumatic multiple organ dysfunction syndrome patients using echocardiography

摘要

摘要:
背景左心房大小是心血管事件发生的预测因子，左心房结构和功能对心血管疾病的诊疗和预后具有重要意义。既往临床对多器官功能障碍综合征(multiple organ dysfunction syndrome，MODS)患者心功能的研究主要关注左、右心室的结构和功能，而对左心房的研究相对较少。
目的探讨应用斑点追踪成像(speckle tracking imaging，STI)相关指标评价创伤性MODS患者左心房功能的可行性。
方法选取2019年1月 - 2022年4月在解放军总医院第一医学中心及战略支援部队特色医学中心确诊的创伤性MODS患者57例，其中男性41例，女性16例，年龄19 ~ 82岁。在确诊MODS的24 h内完成超声心动图检查。采用双平面Simpson法获得左心室射血分数(left ventricular ejection fraction，LVEF)、左心房总排空分数(left atrial total emptying fraction，LATEF)、左心房主动排空分数(left atrial active emptying fraction，LAAEF)和左心房被动排空分数(left atrial passive emptying fraction，LAPEF)。应用STI软件分析获得左心房储器纵向应变(longitudinal strain of left atrial reservoir，LASr)、左心房管道纵向应变(longitudinal strain of left atrial duct，LAScd)和左心房辅泵纵向应变(longitudinal strain of left atrial accessory pump，LASct)。利用ROC曲线评估相关参数对左心房功能的诊断价值，计算曲线下面积。另选取年龄、性别、心血管危险因素与创伤性MODS组相匹配的45例普通创伤患者作为对照组，对比两组左心房收缩功能相关参数的变化。
结果创伤性MODS组LVEF、LATEF、LAAEF、LASr、LAScd和LASct均较对照组降低(P均＜0.01)；ROC曲线分析显示，评价创伤性MODS患者左心房收缩功能时，LATEF、LAAEF、LAPEF、LASr、LAScd、LASct曲线下面积分别为0.789、0.801、0.496、0.943、0.890、0.766，最佳分界值分别为48.07%、26.58%、25.88%、43.15%、-24.86%、-10.25%，敏感度分别为0.80、0.79、0.62、0.89、0.96、0.85，特异度分别为0.53、0.61、0.65、0.74、0.63、0.59。
结论在创伤性MODS早期，左心房储器功能、管道功能和辅泵功能均已受损，LASr 对左心房功能的预测价值最高。STI定量评估左心房纵向应变能够发现患者左心房功能障碍，可为临床综合评估心脏功能提供依据。

Abstract:
Background Left atrial size is a predictor of cardiovascular events, and its structure and function are of great significance for the prognosis of patients. In the past, the structure and function of left and right ventricles are mainly concerned for patients with multiple organ dysfunction syndrome (MODS), while the study of left atrium is relatively few.
Objective To evaluate the left atrial (LA) function in patients with traumatic MODS using two-dimensional speckle tracking imaging (STI).
Methods From January 2019 to April 2022, 57 patients with traumatic MODS were enrolled in the First Medical Center of Chinese PLA General Hospital and Strategic Support Force Medical Center. Of the 57 cases, there were 41 males and 16 females, with age ranging from 19 to 82 years. All these patients accepted echocardiography within 24 hours of diagnosis. The left ventricular ejection fraction (LVEF), LA total ejection fraction (LATEF), LA active ejection fraction (LAAEF) and LA passive ejection fraction (LAPEF) were acquired by the Simpson method. LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct) were acquired by strain analysis software. The ROC curve was used to evaluate the diagnostic value of related parameters for left atrial function, and the area under the curve (AUC) was calculated. In addition, 45 trauma patients matched with age, sex, cardiovascular risk factors were selected as the control group, and the changes of left atrial systolic function related parameters were compared between the two groups.
Results LVEF, LATEF, LAAEF, LASr, LAScd and LASct in the traumatic MODS patients were significantly lower than those in the controls (P<0.01). The ROC curve was used for analyzing the left atrial function, the area under the curve (AUC) of LATEF, LAAEF, LAPEF, LASr, LAScd and LASct were 0.789, 0.801, 0.496, 0.943, 0.890 and 0.766, respectively. The optimal cut-off values were 48.07%, 26.58%, 25.88%, 43.15%, -24.86%, -10.25%, with the sensitivity of 0.80, 0.79, 0.62, 0.89, 0.96, 0.85, the specificity of 0.53, 0.61, 0.65, 0.74, 0.63, 0.59.
Conclusion In the early stage of traumatic MODS, the left atrial reservoir function, ductal function and auxiliary pump function have been impaired, and LASr is the best predictor for LA function among all the parameters. STI can detect the changes of the left atrial function and provide objective evidence for a comprehensive assessment of cardiac function.

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