中文摘要：

目的 应用三维斑点追踪技术（3D-STE）和实时三维超声心动图（RT3DE）评估探讨左室射血分数保留心衰（HFpEF）患者左房功能变化及意义.方法 将43例HFpEF患者根据左房大小分为A组（左房最大容积指数LAVImax＜ 34 mL/m2）和B组（LAVImax≥34 ml/m2）,18例健康者为对照组.应用3 DSTE分析获取左房基底（Basal）、中间（Middle）、房顶（Roof）和整体（Global）的心室收缩期长轴峰值应变（LSs％）与心房收缩前长轴峰值应变（LSa％）,结合RT3 DE和多普勒超声参数进行比较分析.结果 左房中部应变参数具满意可重复性（ICC ＞0.8）,A组左房充盈和排空期形变功能减低以中部为主[与对照组相比：MLSs（33 ±6）％与（45±9）％,MLSa（12±3）％与（17±5）％;P＜0.05],B组基底和房顶部形变功能也明显降低[与A组和对照组相比：BLSs（18 ±7）％与（25±8）％与（29±8）％,RLSs （24±9）％与（28±8）％与（32±10）％;与对照组相比：BLSa（11±5）％与（14士4）％,RLSa（12±5）％与（15±5）％;P＜0.05].HFpEF患者左房僵硬度明显增加,左房充盈扩张分数（LAEI％）和被动射血分数（LAPEF％）明显降低,B组左房主动射血分数（LAAEF％）也显著降低.结论 3D-STE结合RT3DE可有效评估HFpEF左房功能.左房中部应变参数是评估左房功能的理想指标.HFpEF患者左房储备、通道和泵功能均明显降低,存在明显舒张功能不全,这些变化在左房明显增大患者中更为显著.

英文摘要：

Objective To evaluate left atrial function changes inheart failure with preserved ejection fraction （HFpEF） patients by three-dimensional speckle-tracking echocardiography （3D-STE） and Real time three-dimensional echocardiograph（RT3DE）.Methods 43 HFpEF patients and a control group with 18 healthy subjectswere enrolled.According to left atrial max volume index （LAVImax）,patients were grouped as A （LAVImax 〈 34 ml/m2） and B （LAVImax≥34 ml/m2）.3D-STE deformative parameters,left atrial ventricular-systolic longitudinal peak strain （LSs%）and left atrial pre-contraction longitudinal peak strain （LSa%）,from three levels （Basal,Middle and Roof） and global were measured.These parameters combined with RT3DE and Doppler parameters were analyzed between groups.Results Reproducibilities of MLSs and MLSa were satisfactory （ICC 〉 0.8）.In group A,LA filling and emptying deformation reduced mainly in middle level （compared to control group：MLSs （33 ± 6） % vs （45 ± 9） %,MLSa （12 ± 3） % vs （17 ±5）%,P 〈0.05）,while in group B,deformation of basal and roof levels also reduced （compared to A and control group：BLSs （18 ±7）% vs （25 ±8）% vs （29 ±8）%,RLSs （24 ±9）% vs （28 ±8）% vs （32 ±10）%;compared to control group：BLSa （11 ±5）% vs （14 ±4）%,RLSa （12 ±5）% vs （15 ±5）%;all P〈 0.05）.LA stiffness increased while LA expansion index （LAEI%）,LA passive ejection fraction （LAPEF%） decreased significantly in HFpEF patients,LA active ejection fraction （LAAEF%） of group B also decreased.Conclusions 3D-STE in combination with RT3DE enables the assessment of LA function effectively and comprehensively.3D-STE strains of LA middle level were ideal parameters for LA function assessment.HFpEF patients have significantly reduced LA reservoir,conduit,pump function and left ventricular diastolic dysfunction,and these changes were more apparent in patients with LA enlarged significantly.