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目的:探讨采用无心电同步的自动应变评价左心房黏液瘤(LAM)对左心房功能的影响及术后变化。方法:本研究为病例对照研究，选取2023年2月至2023年10月于北部战区总医院心血管外科行左心房占位摘除术的25例LAM患者，男9例，女16例，年龄(56.3±13.9)岁，年龄范围为32～76岁。根据LAM是否引起二尖瓣梗阻将LAM患者分为两组，二尖瓣无梗阻患者为A组( n＝15)，二尖瓣梗阻患者为B组( n＝10)。另选取同时期25名超声心动图与心电图无异常且无临床症状的健康检查者为C组，男10名，女15名，年龄(52.2±16.5)岁，年龄范围为30～75岁。所有纳入者均未连接同步心电图，A、B组于术前1～5 d及术后3～7 d行经胸超声心动图检查，测量瘤体最长径、最宽径、蒂宽。所有纳入者测量左心房内径(LAD)，二尖瓣平均跨瓣压差(MVPG)；采用自动应变测量左心房储库纵向应变(LASr)、左心房导管纵向应变(LAScd)及左心房收缩纵向应变(LASct)。将以上数值进行组间比较及Pearson相关分析。 结果:术前B组患者的LAD[(43.96±5.43)mm]、MVPG[(10.08±4.07)mmHg，1 mmHg＝0.133 kPa]大于C组[(32.13±4.73)mm、(1.75±0.82)mmHg]，A组、B组患者的LASr[(20.54±5.91)%、(10.49±5.03)%]、LAScd[(－10.31±4.09)%、(－5.49±4.01)%]、LASct[(－10.24±4.37)%、(－4.89±2.12)%]绝对值均低于C组[(33.55±7.89)%、(－18.63±6.84)%、(－15.07±6.11)%]，差异有统计学意义( P<0.05)。B组患者最长径[(54.92±18.24)mm]、最宽径[(31.08±8.45)mm]、LAD、MVPG均大于A组[(30.54±9.65)mm、(19.81±5.45)mm]，LASr、LAScd、LASct绝对值均低于A组，差异有统计学意义( P<0.05)。相关性分析显示LASr与LAD( r＝－0.61)、MVPG( r＝－0.59)、最长径( r＝－0.54)、最宽径( r＝－0.56)中度负相关，LAScd与LAD( r＝－0.51)中度负相关，LASct与LAD( r＝－0.54)、MVPG( r＝－0.56)、最长径( r＝－0.53)中度负相关。术后B组患者的LAD[(36.03±6.14)mm]、MVPG[(2.76±2.21)mmHg]大于C组[(32.77±4.60)mm、(1.79±0.71)mmHg]，LAD大于A组[(33.41±4.58)mm]，A、B组患者的LASr[(16.13±3.07)%、(14.52±2.78)%]、LAScd[(－8.34±6.78)%、(－8.46±2.55)%]、LASct[(－6.24±3.91)%、(－6.04±2.37)%]绝对值均低于C组[(33.54±7.92)%、(－18.25±6.36)%、(－15.35±5.98)%]，差异有统计学意义( P<0.05)。 结论:LAM引起左心房形态扩张及左心房储血、管道、辅泵功能降低，瘤体越大则形态改变及功能降低越明显。黏液瘤摘除术后，术前无二尖瓣梗阻者左心房形态无明显改变，左心房储血、辅泵功能进一步降低；术前二尖瓣梗阻者左心房形态可恢复正常，左心房储血功能较术前改善，但各项功能仍低于正常。

Objective:To evaluate the left atrial function and recent postoperative functional changes after removal surgery of left atrial myxoma(LAM) by automatic strain without electrical synchronization.Methods:This study was a case-control study, a total of 25 patients were selected from the department of Cardiovascular Surgery of General Hospital of Northern Theater Command from February 2023 to October 2023, including 9 males and 16 females, aged(56.3±13.9) years old, the age ranging from 32 to 76 years old.Grouped based on whether LAM causeed mitral valve obstruction, patients without mitral valve obstruction as A group( n=15) and patients with mitral valve obstruction as B group( n=10).Another 25 healthy examiners with no abnormalities in echocardiography and electrocardiogram and no clinical symptoms during the same period were selected as C group, including 10 males and 15 females, aged(52.2±16.5) years old, the age ranging from 30 to 75 years old.All participants underwent transthoracic echocardiography without electrical synchronization.A group and B group underwent transthoracic echocardiography 1 to 5 d before surgery and 3 to 7 d after surgery, and measured the longest diameter, widest diameter, and pedicle width of the LAM.All participants measured left atrium diameter(LAD), mitral transmitral pressure gradient(MVPG), and measured the left atrial strain during reservoir phase(LASr), left atrial strain rate during conduit phase(LAScd) and left atrial strain rate during contraction phase(LASct) through automatic strain.Compared the above values between groups and conducted Pearson correlation analysis. Results:Before surgery, the LAD[(43.96±5.43) mm], MVPG[(10.08±4.07)mmHg, 1 mmHg=0.133 kPa]of B group patients were higher than those of C group patients[(32.13±4.73)mm, (1.75±0.82)mmHg].The absolute values of LASr[(20.54±5.91)%, (10.49±5.03)%], LAScd[(-10.31±4.09)%, (-5.49±4.01)%], LASct[(-10.24±4.37)%, (-4.89±2.12)%]in A group and B group were lower than those in C group[(33.55±7.89)%, (-18.63±6.84)%, (-15.07±6.11)%], and the differences were statistically significant( P<0.05).The longest diameter[(54.9±18.24)mm], widest diameter[(31.08±8.45)mm], LAD and MVPG of B group were all higher than those in A group, the absolute values of LASr, LAScd and LASct were lower than those in A group, and the differences were statistically significant( P<0.05).Correlation analysis showed that LASr was moderately negatively correlated with LAD( r=-0.61), MVPG( r=-0.59), longest diameter( r=-0.54) and widest diameter( r=-0.56), LAScd was moderately negatively correlated with LAD( r=-0.51), and LASct was moderately negatively correlated with LAD( r=-0.54), MVPG( r=-0.56) and longest diameter( r=-0.53).After surgery, the LAD[(36.03±6.14)mm], MVPG[(2.76±2.21)mmHg]of B group were higher than those in C group[(32.77±4.60)mm, (1.79±0.71)mmHg], the the LAD was higher than A group[(33.41±4.58)mm].The absolute values of LASr[(16.13±3.07)%, (14.52±2.78)%], LAScd[(-8.34±6.78)%, (-8.46±2.55)%], LASct[(-6.24±3.91)%, (-6.04±2.37)%]in A group and B group were lower than those in C group[(33.54±7.92)%, (-18.25±6.36)%, (-15.35±5.98)%], and the differences were statistically significant( P<0.05). Conclusions:LAM caused the morphological expansion of left atria and reduced the function of blood storage, pipeline and auxiliary pump in left atria, the larger the tumor body, the more obvious the morphological change and function decreased.After myxoma enucleation, the left atrial morphology, blood storage and auxiliary pump function were further reduced; the left atrial morphology returned to normal, and the left atrial blood storage function improved compared with the preoperative operation, but the functions were still lower than normal.