超声斑点追踪成像技术评价肺动脉高压患者右心室功能

Assessment of right ventricular function using ultrasound speckle tracking imaging in patients with pulmonary arterial hypertension

目的应用超声斑点追踪成像技术评价肺动脉高压患者的右心室功能及其影响因素。方法应用超声斑点追踪成像技术测量42例肺动脉高压患者及31例正常对照组的右心室游离壁基底段、中间段及心尖段收缩峰值速度(V)、收缩峰值应变(ε)、收缩峰值应变率(SRs)、舒张早期峰值应变率(SRe)、舒张晚期峰值应变率(SRa),对结果进行组间比较,并分析影响肺动脉高压患者右心室功能的指标。结果肺动脉高压患者各节段ε、SRs、SRe、SRa均较对照组均显著减低(P均<0.05),而V与对照组无明显差异,肺血管阻力和肺动脉收缩压是影响肺动脉高压患者右心室收缩功能的重要因素(r =-0.292～-0.511,r=-0.276～-0.489,P均<0.05),三尖瓣环收缩峰值速度与肺动脉高压患者右心室游离壁基底段V、ε、SRs有良好的相关性(r=0.480～0.622,P<0.01)。结论肺动脉高压患者右心室功能减低,超声斑点追踪成像技术可准确、客观地评价右心室功能。

Objective To assess right ventricular （RV） function in patients with pulmonary arterial hypertension （PAH） and study the factors of right ventrieular function by ultrasound speckle-tracking imaging （STI）. Methods Peak systolic velocity （V）, strain （ε）, strain rate （SRs）, early diastolic strain rate （SRe） and late diastolic strain rate （SRa） were measured in right ventricular free wall for basal, mid and apical segment in 42 patients with PAH and 31 healthy controls by ST/from the apical 4-chamber view and compared between groups to assess the determinants of the RV functional parameters. Results Peak systolic strain （ε）, strain rate （SRs）, early diastolic strain rate （SRe） and late diastolic strain rate （SRa） of all segments significantly decreased in patients with PAH （P〈0. 05）, while peak systolic velocity （V） did not decrease in patients with PAH. Pulmonary vascular resistance and pulmonary artery systolic pressure were important factors of RV function （r =-0. 292～-0. 511 and r=-0. 276～-0. 489, respectively, P〈0. 05 for both）. There were good correlations between tricuspid annular systolic peak velocity and V, e and SR of the right ventricular free wall for basal segment in patients with PAH （r=0. 480-0. 622, P〈0.01）. Conclusion Right ventricular function decreases in patients with PAH. Right ventricular function can be accurately and objectively studied with STI.