超声二维应变成像评价肺动脉高压患者右心室纵向收缩功能

Assessment of right ventricular logitudinal systolic function in patients with pulmonary arterial hypertension by ultrasound 2-dimensional strain

目的应用超声二维应变成像技术评价肺动脉高压患者右心室收缩功能。方法正常对照组31例；肺动脉高压患者42例，根据肺动脉收缩压程度将其分为轻度（17例）、中度（15例）、重度（10例）三组。获取心尖四腔观，应用二维应变技术测量并记录右室整体及游离壁基底段、中间段、心尖段纵向收缩峰值应变（ε）。对三组应变参数进行比较，并分析影响肺动脉高压患者右室功能的指标。结果轻、中、重度肺动脉高压患者右室整体ε及游离壁各节段ε较对照组均显著减低，差异有统计学意义（P均〈0．05），且重度肺动脉高压右心室整体ε及游离壁各节段ε较轻度组显著减低，差异有统计学意义（P〈0．001）。肺血管阻力和肺动脉收缩压是影响肺动脉高压患者右室功能的决定因素（r1=-0．491～-0．641，r2=-0．403—0．489，P均〈0．05），三尖瓣环收缩峰值速度与肺动脉高压右室整体ε及游离壁各节段ε有良好的相关性（r=0．463-0．587，P〈0．001）。结论肺动脉高压患者的右室功能减低，超声二维应变成像可准确、客观地评价右室长轴收缩功能。

Objective To assess right ventricular（RV） systolic function in patients with pulmonary arterial hypertension （PAH） by 2-dimensional strain （2DS）. Methods According to pulmonary artery systolic pressure,patients with PAH were divided into mild （ 17）, moderate （ 15 ） and severe （10） PAH groups. Logitudinal peak systolic strain values were measured in RV global and free wall for basal,mid and apical segment in 42 patients with PAH and 31 healthy controls by 2DS from the apical 4-chamber view,and compared between groups and assessed the determinants of the RV functional parameters. Results Logitudinal peak systolic strain of RV global and free wall for all segments were significantly impaired in patients with PAH compared with controls and were most altered in patients with the severe PAH group compared with mild patients （P 〈 0.05 for all）. Pulmonary vascular resistance and pulmonary artery systolic pressure were the determinants of RV function （ r1 = - 0.491 - - 0. 641 and r2 = - 0. 403 -0. 489,respectively,P〈0.05 for both）. There were good correlations between tricuspid annular systolic peak velocity and strain of all segments in patients with PAH （ r = 0. 463-0. 587, P〈0. 001）. Conclusions RV function in patients with PAH was decreased,RV longitudinal systolic function can be accurately and objectively studied by 2DS.