超声心动图对正常成人右心结构及功能的评估

Echocardiographic assessment of right heart in normal adults

目的探讨超声心动图对正常成人右心结构及功能的评估价值。方法于2011年11月至2012年11月期间,对130例正常成人行右心及常规左心超声心动图检查,具体方法参照美国超声心动图学会(ASE)2010年推荐的超声心动图评估右心功能指南。计算中国正常成人右心功能超声心动图参数的参考范围,并分析各年龄组间各参数有无差异。结果右心功能部分参数不同年龄组间差异有统计学意义,中年组右心房左右径大于青年组[(36.90±5.10)mmvs(33.90±5.20)mm,t=-2.79,P=0.006],青年组右心房上下径与右心房面积小于中年组及老年组[(40.10±5.10)mmvs(42.90±5.10)mm、(43.40±5.60)mm,t=-2.51、-2.91,P=0.013、0.004;(11.90±3.20)cm2vs(13.40±2.90)mm2、(13.90±3.60)mm2,t=-2.24、-2.90,P=0.027、0.004],青年组胸骨旁长轴(PLAX)右心室流出道(RVOT)、大动脉短轴(PSAX)RVOT近端内径与主肺动脉内径(PAD)均小于中年组及老年组[(24.20±3.00)mmvs(26.20±2.30)mm、(25.90±2.90)mm,t=-2.80、-2.32,P=0.006、0.022;(24.70±3.00)mmvs(27.20±2.50)mm、(26.90±2.60)mm,t=-4.40、-3.84,P=0.000、0.000;(20.60±2.00)mmvs(22.10±2.70)mm、(21.90±2.10)mm,t=-3.12、-2.67,P=0.002、0.008],青年组RV游离壁厚度小于中年组及老年组[(5.10±0.60)mmvs(5.60±0.60)mm、(5.40±0.70)mm,t=-3.12、-2.22,P=0.02、0.028];青年组组织多普勒(DTI)e峰大于中年组及老年组[(14.9±3.7)cm/svs(10.9±3.1)cm/s、(11.10±2.60)cm/s,t=5.82、5.49,P=0.000、0.000],青年组DTIa峰小于中年组及老年组[(12.50±3.90)cm/svs(14.60±3.70)cm/s、(16.60±3.60)cm/s,t=-2.79、-5.04,P=0.007、0.000],中年组DTIa峰小于老年组(t=-2.26,P=0.02),青年组三尖瓣E峰大于中年组及老年组[(0.61±0.11)m/svs(0.51±0.11)m/s、(0.48±0.08)m/s,t=4.58、5.44,P=0.000、0.000]。青年组E/A大于中年组及老年组(1.45±0.30vs1.12±0.33、1.10±0.27,t=4.58、5.44,P=0.000、0.000)。不同年龄组右心收缩功能差异无明显统计学意义,右心舒张功能随年龄增大有递减趋势。结论超声心动图可定量评估正常成人右心结构和功能。

Objective To discuss the value of echocardiography for the assessment of structure and function of right heart in normal Chinese adults Methods The structure and function of right heart was assessed by echocardiography according to 2010 guideline of American Society of Echocardiography (ASE). The echocardiographic data of right heart of 130 normal Chinese adults were analyzed to acquire the normal reference values of echocardiographic parameters and evaluate the differences of these results among different age groups. Results There were significant differences among different age groups for some of the parameters. Right atrium (RA) transverse diameter was greater in the middle-aged group than that in the young-aged group [(36.90±5.10) mm vs (33.90±5.20) mm, t=-2.79, P=0.006]. RA longitudinal diameter (RAL) and RA area (RAA) were smaller in the young-aged group than those in the middle-aged and old-aged groups [(40.10±5.10) mm vs (42.90±5.10) mm, (43.40±5.60) mm, t=-2.51 and-2.91, P=0.013 and 0.004;(11.90±3.20) mm2 vs (13.40±2.90) mm2, (13.90±3.60) mm2, t=-2.24 and-2.90, P=0.027 and 0.004]. Parasternal long-axis right ventricule outflow tract (PLAX RVOT), parasternal short-axis right ventricule outflow tract (PSAX RVOT) and pulmonary artery diameter (PAD) were smaller in the young-aged group than those in the middle-aged and old-aged groups [(24.20±3.00) mm vs (26.20±2.30) mm, (25.90±2.90) mm, t=-2.80 and-2.32, P=0.006 and 0.022;(24.70±3.00) mm vs (27.20±2.50) mm, (26.90±2.60) mm, t=-4.40 and -3.84, P=0.000 and 0.000; (20.60±2.00) mm vs (22.10±2.70) mm, (21.90±2.10) mm, t=-3.12 and-2.67, P=0.002 and 0.008]. RV lateral wall thickness was smaller in the young-aged group than that in the middle-aged and old-aged groups [(5.10±0.60) mm vs (5.60±0.60) mm, (5.40±0.70) mm, t=-3.12 and-2.22, P=0.02 and 0.028];DTI e wave was greater in the young-aged group than that in the middle-aged and old-aged groups [(14.90±3.70) cm/s vs (10.90±3.10) cm/s, (11.10±2.60) cm/s, t=5.82 and 5.49, P=0.000 and 0.000]. DTI a wave was smaller in the young-aged group than that in the middle-aged and old-aged groups [(12.50±3.90) cm/s vs (14.60±3.70) cm/s, (16.60±3.60) cm/s, t=-2.79 and -5.04, P=0.007 and 0.000] and DTI a wave was smaller in the middle-aged group than that in the old-aged group (t=-2.26, P=0.02). Tricuspid E wave was greater in the young-aged group than that in the middle-aged and old-aged groups [(0.61±0.11) m/s vs (0.51±0.11) m/s, (0.48±0.08) m/s, t=4.58 and 5.44, P=0.000 and 0.000]. E/A was greater in the young-aged group than that in the middle-aged and old-aged groups (1.45±0.30 vs 1.12±0.33, 1.10±0.27, t=4.58 and 5.44, P=0.000 and 0.000). No significant differences were found among different age groups in RV systolic function parameters, whereas a trend of decrease in RV diastolic function was detected. Conclusion Echocardiography can be useful in assessing the structure and function of right heart quantitatively.