摘要
目的应用超声三维斑点追踪成像技术评价业余超级马拉松运动员左心房结构和功能改变。方法2023年6月至2024年6月回顾性纳入业余马拉松运动员90例,其中业余超级马拉松(跑程≥50 km)运动员44例(UM组),业余经典马拉松(跑程<50 km)运动员46例(M组)。另选取同期在杭州师范大学附属医院体检的健康志愿者39例作为对照组。记录业余马拉松运动员的周跑量、跑龄。所有的受检者均采用常规超声心动图联合三维斑点追踪超声心动图(3D-STE)获得左心房容积及功能参数,包括左心房前后径(LAd)、舒张末期左心室内径(LVEDd)、左心室射血分数(LVEF)、二尖瓣口舒张早期峰值流速(E)、二尖瓣环外侧舒张早期峰值速度(e''),计算E/e'';左心房最小、最大、收缩前容积(LAVmin、LAVmax、LAVpreA),左心房最大容积指数(LAVImax),左心房排空容积(LAEV),左心房整体、主动、被动射血分数(LAEF、LAaEF、LApEF),左心房膨胀指数(LAEI),左心房储备期、管道期、收缩期长轴及圆周应变(LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c)。比较三组间左心房参数的差异,并分析影响LAEF的相关因素。结果三组间LAd、LVEDd、LAVmin、LAVmax、LAVpreA、LAVImax、LAEV差异有统计学意义(均P<0.05),组间两两比较差异有统计学意义(均P<0.05)。与对照组比较,M组、UM组LAEF、LApEF、LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c显著减低(均P<0.05),UM组与M组上述参数差异无统计学意义(均P>0.05);三组间IVSd、LVEF、E/e''、LAaEF、LAEI差异无统计学意义(均P>0.05)。多元线性回归模型分析周跑量是业余马拉松运动员LAEF降低的独立预测因子。重复性检验显示观察者内和观察者间一致性良好。结论业余马拉松运动员左心房储备功能、管道功能、收缩功能均有不同程度受损,而业余超级马拉松运动员更为显著,3D-STE技术可以评价业余超级马拉松运动员左心房的结构和功能改变,以辅助临床更好地了解业余超级马拉松运动员的心房适应。
Objective:To evaluate the structural and functional changes of the left atrium in amateur ultra-marathon runners using ultrasound three-dimensional speckle tracking imaging technology.Methods:From June 2023 to June 2024,90 amateur marathon athletes were retrospectively recruited,including 44 amateur ultra-marathon(running distance≥50 km)athletes(Ultra-marathon,UM group)and 46 amateur classic marathon(running distance<50 km)athletes(Marathon,M group).Another 39 healthy volunteers who underwent physical examinations in Hangzhou Normal University Affiliated Hospital at the same time were selected as the control group.The distance,running age of amateur marathon runners were recorded.All subjects which underwent conventional echocardiography combined with three-dimensional speckle tracking echocardiography(3D-STE)obtained left atrial volume and functional parameters,including two-dimensional ultrasound indicators such as left atrial anterior posterior diameter(LAd),left ventricular end-diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF),early diastolic peak velocity at the mitral valve orifice(E),and early diastolic peak velocity at the lateral mitral annulus(e'),E/e',left atrial minimum,maximum,presystolic volumes(LAVmin,LAVmax,LAVpreA),left atrial maximum volume index(LAVImax),left atrial emptying volume(LAEV),overall left atrial ejection fraction,active and passive ejection fraction(LAEF,LAaEF,LApEF),left atrial expansion index(LAEI),left atrial reservoir period,conduit period,systolic long axis and circumferential strain(LASr,LAScd,LASct,LASr-c,LAScd-c,LASct-c).The differences in left atrial parameters among three groups were compared and the relevant factors affecting LAEF were analyzed.Results:There were statistically significant differences in LAd,LVEDd,LAVmin,LAVmax,LAVpreA,LAVImax,and LAEV among the three groups(all P<0.05),and there were statistically significant differences in pairwise comparisons between the groups(all P<0.05).Compared with the control group,LAEF,LApEF,LASr,LAScd,LASct,LASr-c,LAScd-c and LASct-c were significantly reduced in the M and UM groups(all P<0.05),while there were no statistically significant differences in these parameters between the UM and M groups(all P>0.05);There were no statistically significant differences in IVSd,LVEF,E/e',LAEI,and LAaEF among the 3 groups(all P>0.05).There were no statistically significant differences in IVSd,LVEF,E/e',LAaEF and LAEI among the 3 groups(all P>0.05).Multiple linear regression analysis showed that only weekly running volume was an independent predictor of decreased LAEF in amateur marathon runners.The repeatability test indicated good consistency within and between observers.Conclusions:Amateur marathon runners have varying degrees of damage to their left atrial reservoir function,conduit function,and contraction function,with amateur ultra-marathon runners showing more significant damages,3D-STE technology can evaluate the structural and functional changes in the left atrium in amateur ultra-marathon athletes,and assist clinical understanding of atrial adaptation in amateur ultra-marathon athletes.
作者
陈丽
李波
杨寸芯
龙莉梅
张贺彬
马迎
Chen Li;Li Bo;Yang Cunrin;Long Limei;Zhang Hebin;Ma Ying(Department of Ultrasound,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)
出处
《中华超声影像学杂志》
北大核心
2025年第2期122-128,共7页
Chinese Journal of Ultrasonography
基金
浙江省医药卫生科技计划项目(2024KY1341)
杭州卫生科技计划项目(A20200133)。
关键词
超声心动描记术
超级马拉松
左心房
三维斑点追踪成像
结构
功能
Echocardiography
Ultra-marathon
Left atrium
Three-dimensional speckle tracking imaging
Structure
Function
