三维超声及组织速度向量技术对肺动脉高压右心衰竭患者的右心房收缩同步性的评估

Evaluation of Right Atrial Function in Patients With Right Ventricular Dysfunction and Pulmonary Hypertension by Real-time Three-dimensional Echocardiography and Tissue Velocity Vector Imaging

目的:应用三维超声及组织速度向量(VVI)技术对肺动脉高压右心功能障碍患者的右心房功能及收缩同步性进行研究。方法:选取我院确诊的肺动脉高压患者86例,为肺动脉高压组,并根据三维右心室射血分数(RVEF)分为两个亚组:RVEF≤40%亚组和RVEF>40%亚组,每组43例,选择38例健康人作为对照组。应用VVI技术测量右心房三个节段的应变、应变率、整体应变、整体应变率、右心房应变达峰时间标准差(TS-SD),右心房应变率达峰时间标准差(TSR-SD)、右心房射血分数(RAEF)、右心房每搏量(RASV)、右心房舒张末期容积(RAEDV)和右心房收缩末期容积(RAESV),评估患者右心房失同步性,并分析各参数之间的关系。结果(:1)与对照组相比,RVEF≤40%亚组患者的RAEF明显减低,RAEDV、RAESV、RASV均增加。(2)肺动脉高压组患者的右心房各节段应变、整体应变、整体应变率呈递减趋势。与对照组比较,RVEF>40%亚组、RVEF≤40%亚组的右心房整体应变、右心房整体应变率均减低(P均<0.05)。与RVEF>40%亚组相比,RVEF≤40%亚组的右心房整体应变降低(P<0.05)(;3)与对照组相比,RVEF>40%亚组、RVEF≤40%亚组的右心房收缩同步性指标SD-TS、TSR-SD均延迟,与RVEF>40%亚组比较,RVEF≤40%亚组的SD-TS、TSR-SD均延迟(P均<0.05)。(4)Pearson相关性分析显示,右心房SD-TS与肺动脉收缩压(PASP)呈正相关(r=0.283,P=0.019),与右心房整体应变(r=-0.231,P=0.011)、RVEF(r=-0.534,P=0.000)呈负相关;TSR-SD与PASP呈正相关(r=0.219,P=0.014),与右心房整体应变(r=-0.203,P=0.027)、RVEF(r=-0.382,P=0.001)呈负相关。结论:肺动脉高压患者的右心房整体及局部收缩功能减低,右心房收缩失去同步性,且随着右心室收缩功能障碍,变化更加明显。速度向量成像技术及三维超声技术可敏感地评估肺动脉高压患者右心房功能及收缩同步性。

Objectives:To assess the right atrial function and systolic synchronization in patients with right ventricular dysfunction and pulmonary hypertension by three-dimensional echocardiography and tissue velocity vector(VVI). Methods:86 patients with pulmonary hypertension diagnosed in our hospital were divided into two groups according to right ventricular ejection fraction derived from three-dimensional echocardiography: RVEF ≤ 40% group and RVEF > 40% group(n=43 each), 38 healthy people served as control group. The strain, strain rate(SR), global strain(Globle S), global strain rate(Globle SR), right atrium strain peak time(SD-TS) in three segments of right atrium was measured by VVI technique. Right atrial strain rate peak time standard deviation(SD-TSR), right atrial ejection fraction(RAEF), right atrial stroke volume(RASV), right atrial end diastolic volume(RAEDV), right atrial end systolic volume(RAESV) were also acquired to evaluate the synchrony of the right atria and the relationship between these parameters was analyzed. Results:(1) Compared with the control group, the RAEF value was lower, while RAEDV, RAESV, RASVvalues were all increased in RVEF≤40% group.(2) The strain, globle S, globle SR of right atrium in each segment of PH group showed a decreasing trend, globle S and global SR of right atria were lower inRVEF > 40% group and RVEF ≤ 40% group than in control group. Globle S was lower in RVEF ≤ 40% group than in RVEF > 40% group(P<0.05).(3) SD-TS and SD-TSR were delayed in pulmonary hypertension group compared with normal control group. SDTS and SD-TSR delay was more significant in RVEF ≤ 40% group than in RVEF > 40% group(both P<0.05).(4)Pearson correlation analysis showed that SD-TS of right atria was positively correlated with PASP(r =0.283, P=0.019), negatively correlated with the overall strain of right atrium(r=-0.231, P=0.011) and right ventricular RVEF(r =-0.534, P =0.000). TSR-SD of the right atria was positively correlated with PASP(r = 0.219, P =0.014), negatively correlated with the overall strain of the right atrium(r=-0.203, P=0.027) and the right ventricular RVEF(r=-0.382, P=0. 001). Conclusions:In PH group, the global and local systolic function of the right atrium is decreased, and complicated with right atrium dsynchronization, and the change is more obvious with decreasing RVEF. VVI and three-dimensional echocardiography can be used to evaluate the synchronization of right atrium andfunction in patients with PH.