经食管超声心动图研究主动脉根部解剖与房间隔活动度

doi:10.3969/j.issn.1004-583X.2023.11.009

摘要/Abstract

摘要：

目的探讨主动脉窦部直径与房间隔活动度(atrial septal mobility,ASM)之间的关系。方法回顾性收集经食管超声心动图(transesophageal echocardiography,TEE)检查患者103例,评估ASM和房间隔前后长度、主动脉根部直径及卵圆孔未闭(patent foramen ovale, PFO)和房间隔膨出瘤(atrial septal aneurysm, ASA)的发生率。从患者的电子病历和经胸超声心动图报告中获取年龄、性别、体重、身高、既往卒中、心房颤动病史、TEE指征、左心室射血分数、左心房前后直径和左心室舒张功能情况。采用线性回归模型分析ASM与主动脉根部直径的相关关系。结果 103例患者中,测得ASM平均值为4.3 mm;ASA 10例,患病率为9.7%; PFO 46例,患病率为44.7%。根据年龄、性别、体重、身高和左心房前后直径调整后,主动脉根部直径每增加10 mm,ASM增加6.3 mm(B=0.63; $P$ <0.01)。主动脉根部直径与房间隔前后径无关( $P$ =0.083)。结论房间隔活动度的增加与主动脉扩张有关。在房间隔特征和栓塞性卒中风险的相关性研究中应考虑主动脉根部的解剖学特点。

关键词: 经食道超声心动图, 房间隔动脉瘤, 主动脉扩张, 卒中

Abstract:

Objective To investigate the correlation between aortic sinus diameter and atrial septal mobility (ASM). Methods A total of 103 patients who underwent transesophageal echocardiography (TEE) were retrospectively collected. ASM, anterior and posterior diameter of interatrial septum, aortic root diameter, and incidence of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were reviewed and evaluated. Age, sex, weight, height, previous stroke, medical history of atrial fibrillation, TEE indication, left ventricular ejection fraction, left atrial diameter, and left ventricular diastolic function were obtained from the electronic medical records and TEE reports. Linear regression model was used to analyze the correlation between ASM and aortic root diameter. Results In 103 patients, the mean ASM was 4.3 mm. The prevalence of ASA and PFO was 9.7%(10/103) and 44.7%(46/103), respectively. After adjustment for age, sex, weight, height and left atrial size, ASM increased by 6.3 mm for every 10 mm increase in aortic root diameter (B=0.63; $P$ <0.01). There was no correlation between aortic root diameter and anteroposterior diameter of atrial septum ( $P$ =0.083). Conclusion The increased ASM may be related to aortic dilatation. Aortic root diameter should be considered in studies of the association between atrial septal characteristics and the risk of embolic stroke.

Key words: transesophageal echocardiography, atrial septal aneurysm, aortic dilation, stroke

中图分类号:

R540.45
R541

李丽沙, 申向辉, 刘延峰, 任彦斌. 经食管超声心动图研究主动脉根部解剖与房间隔活动度[J]. 临床荟萃, 2023, 38(11): 1012-1015.

Li Lisha, Shen Xianghui, Liu Yanhui, Ren Yanbin. Aortic root anatomy and atrial septal mobility analyzed by transesophageal echocardiography[J]. Clinical Focus, 2023, 38(11): 1012-1015.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.11.009

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I11/1012

图/表 5

图1 经食管超声心动图 a.在主动脉窦平面的主动脉测量; b.房间隔大小和移动度

Fig. 1 TEE a.Aortic measurements at Valsalva sinus plane; b.Interatrial septal size and oscillation

表1 经食管超声心动图测量及患者临床指标( n=103)

Tab.1 Transesophageal echocardiographic measurements and findings of patients with clinically indicated studies( n=103)

项目	数据
经食管超声图像
主动脉根部直径(mm)	32.2±3.5
主动脉瓣[例(%)]
正常	92(89.3)
钙化	10(9.7)
狭窄	1(1.0)
房间隔直径(mm)	25.6±5.1
房间隔活动度(mm)	4.3±3.1
ASA[例(%)]	10(9.7)
PFO[例(%)]	46(44.7)
经胸超声图像
左房前后径(mm)	35.7±6.5
LVEF[例(%)]
≤50%	12(11.7)
>50%	91(88.3)
舒张功能[例(%)]
正常	63(61.2)
功能受限	40(38.8)

图2 房间隔活动度与主动脉窦部直径的相关性

Fig. 2 Correlation between atrial septal mobility and aortic root diameter

表2 主动脉根部直径与ASM之间未调整和调整的线性回归系数

Tab. 2 Crude and adjusted linear regression coeffificients between aortic root diameter and ASM

主动脉直径	B系数	95% $C I$	$P$
未调整	0.50	0.349~0.642	<0.01
调整后
年龄	0.013	-0.024~0.051	0.487
性别	4.184	2.754~5.613	<0.01
体重	-0.036	-0.095~0.025	0.226
身高	0.17	0.044~0.297	<0.01
左房前后径	-0.30	-0.116~0.057	0.501
多变量调整^*	0.63	0.477~0.784	<0.01

表2 主动脉根部直径与ASM之间未调整和调整的线性回归系数

Tab. 2 Crude and adjusted linear regression coeffificients between aortic root diameter and ASM

主动脉直径	B系数	95% $C I$	$P$
未调整	0.50	0.349~0.642	<0.01
调整后
年龄	0.013	-0.024~0.051	0.487
性别	4.184	2.754~5.613	<0.01
体重	-0.036	-0.095~0.025	0.226
身高	0.17	0.044~0.297	<0.01
左房前后径	-0.30	-0.116~0.057	0.501
多变量调整^*	0.63	0.477~0.784	<0.01

表3 房间隔偏移方向与PFD患病情况[例(%)]

Tab. 3 Direction of atrial septal excursion and prevalence of patent foramen ovale (n[%])

组别	例数	PFO
无偏移	13	2(15.4)
右偏移	80	37(46.2)^*
左偏及左右偏移	10	7(70.0)^*
χ²值		7.188
$P$ 值		0.027

表3 房间隔偏移方向与PFD患病情况[例(%)]

Tab. 3 Direction of atrial septal excursion and prevalence of patent foramen ovale (n[%])

组别	例数	PFO
无偏移	13	2(15.4)
右偏移	80	37(46.2)^*
左偏及左右偏移	10	7(70.0)^*
χ²值		7.188
$P$ 值		0.027

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