组织追踪显像对肺心病患者右室壁局部心肌运动的定量分析研究

Quantitative analysis of regional myocardial motions of right ventricular walls in the patients with Cor pulmonale

目的探讨应用组织追踪显像技术评价肺心病患者右室壁局部心肌运动的价值。方法选择52例肺心病患者（肺心病组）及53例体健者（对照组），分别获取两组对象右室前壁、下壁及侧壁的基底段、中段、心尖段心内膜下心肌层的位移曲线，然后测定每一曲线上的收缩期峰值位移（PDs），将各节段PDs值与右室射血分数（RVEF）进行相关性分析；并利用受试工作特征曲线确定两组间有差异的参数的诊断界值。结果（1）肺心病组患者前、下、侧壁的基底段及前壁中段PDs值均明显小于正常组（P〈0.05或0.01）；（2）右室前壁基底段PDs界值为8.5mm的诊断价值相对较大，其灵敏度、特异度、准确率分别为62.75％、65.38％、64.07％；（3）肺心病组患者右室下壁及前壁基底段PDs与RVEF呈显著正相关（r=0.36、0.33，均P〈0.01）。结论组织追踪技术能够评价肺心病患者右室壁部分节段的局部心肌收缩功能，部分节段的PDs值一定程度上能够间接反映肺心病患者的右室整体收缩功能，其中基底段是组织追踪显像检测肺心病患者右室壁局部心肌运动时的最重要节段。

Objective To evaluate the technique of tissue tracking imaging in estimating regional myocardial motions of right ventricular walls in patients with Cor pulmonale. Methods The displacement curves were obtained in subendocardial layers of basal, mid and apical segments of anterior, inferior and lateral walls of right ventricular, and the peak systolic displacements （PDs） were measured in 52 patients with Cor pulmonate and 53 healthy controsl. The linear correlations were analyzed between PDs of each segment of right ventricular walls and the right ventricular ejection fraction （RVEF） in Cor pulmonale patients. The diagnostic dividing values of PDs, which were significantly different from control groups were defined by receiver operating characteristic curves （ROC）. Results In Cor pulmonale group, the mean values of PDs in basal segments of anterior, inferior, lateral walls and in mid segments of anterior walls were all lower than those in control group （P〈0.05）. If the dividing value of PDs of basal segment of anterior wall was 8.5mm, the sensitivity, specificity and accuracy rate were 62.75% ,65.38% ,64.07%, respectively. Among the measurements of PDs of all of segments which were analyzed by linear correlations,the line correlations of PDs of basal segment of inferior walls were highest （r=0.36, P〈0.01）. Conclusion The regional myocardial systolic functions of segments of right ventricular walls in the patients with Cor pulmonale can be estimated by tissue tracking techniques.