摘要： 目的 评估超声心动图估测急性二尖瓣反流（MR）、MR合并左心室舒张功能障碍（LVDD）犬左心房压（LAP）的能力。方法 选择8只健康成年比格犬，经导管活检钳夹断腱索制作急性MR模型（MR组），然后通过导管将塑料微球悬液缓慢注入冠状动脉窦造成LVDD，制作急性MR合并LVDD模型（MR+LVDD组）。每个模型制作成功后，分别间隔60 min先后2次采集二尖瓣口脉冲多普勒频谱、二尖瓣环组织多普勒频谱，每个模型共16个测量点，用Nagueh公式计算左心房压（LAP_ECHO），LAP_ECHO=（1.24×[E/e’]+1.9）。采用导管法测量同一心动周期的左心房压（LAP_C）。结果 MR组和MR+LVDD组平均LAP_C分别为（13.33±1.78）和（18.77±0.92）mmHg，2组比较差异有统计学意义（P<0.001），E/e’分别为（10.73±2.14）和（10.44±1.27）mmHg，2组比较差异无统计学意义（P=0.555）。MR组LAP_ECHO与LAP_C呈线性正相关（r=0.881，P<0.001），MR+LVDD组LAP_ECHO与LAP_C呈线性负相关（r=-0.897，P<0.001）。分析测得的MR组与MR+LVDD组全部32组数据，LAP_ECHO与LAP_C无线性相关性（r=0.131，P=0.473）；排除MR+LVDD组中E/A>1的10组数据，剩余22组数据中LAP_ECHO与LAP_C则呈正相关（r=0.731，P<0.001）。结论 超声心动图可以估测急性MR比格犬LAP，对于急性MR合并LVDD的比格犬，超声心动图估测LAP的能力仍有待进一步验证。

超声心动图估测急性二尖瓣反流合并左心室舒张功能障碍犬左心房压的准确性

郑海宁^1,2, 金岩³, 付煜玮², 张佳琦⁴, 王辉山³, 温朝阳^1,2

1. 解放军医学院研究生院, 北京 100853;
2. 北京大学国际医院超声科, 北京 102206;
3. 中国人民解放军北部战区总医院心外科, 沈阳 110016;
4. 中国医学科学院阜外医院超声科, 北京 100037

收稿日期:2020-03-18出版日期:2020-11-30发布日期:2020-10-31
通讯作者:温朝阳E-mail:wency301@vip.sina.com
作者简介:郑海宁(1983-),男,主治医师,硕士研究生.
基金资助:国家自然科学基金（81771833）；北京市自然科学基金（7172209）


关键词: 左心室舒张功能障碍, 左心房压, 组织多普勒, 二尖瓣反流
Abstract: Objective To evaluate the ability of echocardiography to estimate left atrial pressure(LAP)in beagle dogs with acute mitral regurgitation(MR)and MR combined with left ventricular diastolic dysfunction(LVDD). Methods Eight healthy adult dogs were selected to establish an acute MR model(MR group)and MR combined with LVDD model(MR+LVDD group). After the successful establishment of the two dog models,the pulsed Doppler spectrum of mitral blood flow and the tissue Doppler spectrum of mitral annulus were collected twice at an interval of 60 min,and the LAP curve(LAP_C)was recorded synchronously. The LAP_ECHO was calculated using the Nagueh formula(LAP_ECHO=1.24×[E/e']+1.9). There were 16 measurement points for each model. Results The LAP_C of the MR and MR+LVDD group was 13.33±1.78 mmHg and 18.77±0.92 mmHg,respectively,which was significantly different(P<0.001). E/e' was 10.73±2.14 and 10.44±1.27,respectively,without a statistically significant difference(P=0.555). There was a linear positive correlation between LAP ECHO and LAP_C in the MR group(r=0.881,P<0.001),and a negative correlation between LAP_ECHO and LAP_C in the MR+LVDD group(r=-0.897,P<0.001). By analyzing all 32 measurements from the MR and MR+LVDD groups,there was no linear correlation between LAP ECHO and LAP_C(r=0.131,P=0.473). After excluding 10 measurements of E/A>1 from the MR+LVDD group,LAP_ECHO was still positively correlated with LAP_C in the remaining 22 measurements with E/A<1(r=0.731,P<0.001). Conclusion Echocardiography is able to estimate LAP in dogs with acute MR. For dogs with acute MR combined with LVDD,the ability of echocardiography to estimate LAP remains to be further verified.
Key words: left ventricular diastolic dysfunction, left atrial pressure, tissue Doppler, mitral regurgitation
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