The Clinical Study On Right Atrial Structure And Function Of Different Left Ventricular Geometry In Patients With Obstructive Sleep Apnea Syndrome By Real-time Three-dimensional Echocardiography

Objective:To evaluate right atrial(RA)structure and function of different left ventricular geometry in patients with OSAS by RT-3DE.Methods:One hundred and ninety-nine patients with habitual snoring were diagnosed as OSAS by polysomnography with AHI≥5/h.At the same time,50 healthy people with normal gender,age matching,blood sugar,blood lipids,electrocardiogram and chest X-ray were celected as the control group.Blood pressure and general clinical characteristics were collected and echocardiography was done next morning.On the basis of LVMI≥(male)108g/m~2 or 99g/m~2(female),RWT≥0.51(male)or 0.49(female),LVDd≥55mm(male)or 50mm(female),patients were divided into 6 groups:normal geometry(NG),concentric remodeling(CR),eccentric non dilated hypertrophy(ND-EH),concentric non dilated hypertrophy(ND-CH),eccentric dilated hypertrophy(D-EH),and concentric dilated hypertrophy(D-CH).Full volume images at apical four-chamber view were collected.Right atrial volume-time curve,RAVmax,RAVmin,RAVpre-a were analyzed with QLab workstation.Following parameters includingRA maximum volume(RAVmax),RA minimum volume(RAVmin),RA pre-contraction volume(RAVpre-a)were analyzed with QLab workstation.Following parameters including RA total emptying volume(RA TotEV),RA total emptying fraction(RA TotEF),RA passive emptying volume(RA PassEV),RA passive emptying fraction(RA PassEF),RA active emptying volume(RA ActEV),RA active emptying fraction(RA ActEF)were calculated,All structural parameters are corrected by BSA.Results:(1)RA structural parameters:Compared with N and NG groups,RAVmax,RAVmin,RAVmin/BSA,RAVpre-a and RAVpre-a/BSA were increased in ND-EH,ND-CH and D-(CH+EH)groups(P<0.05);Compared with N,NG and CR groups,RAVpre-a and RAVpre-a/BSA were increased in ND-EH,ND-CH and D-(CH+EH)groups,RAVmax,RAVmax/BSA,RAVmin,RAVmin/BSA,RAVpre-a and RAVpre-a/BSA were increased in ND-CH and D-(CH+EH)groups(P<0.05);Compared with N,NG,CR and ND-EH groups,RAVmax,RAVmax/BSA,RAVpre-a and RAVpre-a/BSA were increased in ND-CH、D-(CH+EH)groups,RAVmin and RAVmin/BSA were increased in D-(CH+EH)group(P<0.05);Compared with N,NG,CR,ND-EH and ND-CH groups,RAVpre-a and RAVpre-a/BSA were increased in D-(CH+EH)group(P<0.05)(2)RA reservoir function parameters:compared with N,NG and CR groups,RA ActEV was increased in ND-CH and D-(CH+EH)groups(P<0.05);Compared with N,NG,CR and ND-EH groups,RA ActEV was increased in D-(CH+EH)group(P<0.05);(3)RA conduit function parameters:compared with N,NG and CR groups,RA PassEF was decreased in ND-EH,ND-CH and D-(CH+EH)groups,RA PassEV was decreased in ND-CH and D-(CH+EH)groups(P<0.05);Compared withN,NG,CR and ND-EH groups,RA PassEV was decreased in D-(CH+EH)group,RA PassEF was decreased in ND-CH and D-(CH+EH)groups(P<0.05);(4)RA pump function parameters:compared with N,NG and CR groups,RAActEF was increased in ND-CH and D-(CH+EH)groups(P<0.05);Compared with N,NG,CR and ND-EH groups,RA ActEV was increased in ND-CH and D-(CH+EH)groups(P<0.05).Conclusion:Different Left ventricular geometric patterns have different RA structure and function in OSAS,patients with ND-CH and D-(CH+EH)have worse structure and function of RA.It is suggested that the clinical need to pay attention to the right atrial structure and function of OSAS patients with dilated LVH.