右心室心肌等容舒张间期评估左向右分流先天性心脏病肺动脉压

RIGHT VENTRICULAR MYOCARDIAL ISOVOLUMIC RELAXATION TIME EVALUATION OF PULMONARY ARTERY PRESSURE IN PAIENTS WITH LEFT TO RIGHT SHUNT CONGENITAL HEART DISEASE

目的:探讨右心室心肌等容舒张间期在评估左向右分流先天性心脏病(CHD)肺动脉压的临床价值。方法:对61例左向右分流CHD患者及30例正常受检者应用脉冲多普勒通过三尖瓣口及肺动脉瓣口测量并计算右心室血流等容舒期间期(IVRTb);脉冲组织多普勒测量三尖瓣前瓣瓣环右心室心肌等容舒张间期(IVRTm);IVRTb、IVRTm用心率校正得出IVRTcb、IVRTcm;心导管测量CHD患者的肺动脉收缩压(PASP)及肺动脉平均压(PAMP)。结果:CHD合并肺动脉高压(PAH)患者IVRTcb、IVRTcm大于CHD不合并PAH患者及正常受检者(P<0.01);IVRTcm,IVRTcb与PASP呈正相关1)(r=0.89,P<0.01;r=0.79,P<0.01);IVRTcm,IVRTcb与PAMP呈正相关(r=0.81,P<0.01;r=0.72,P<0.01);IVRTcm判定PAH敏感度、特异度优于IVRTcb;其中IVRTcm>63.5ms判定PAH敏感度、特异度分别90.3%、86.7%。结论:多普勒组织成像检测三尖瓣环IVRT能定量估测左向右分流CHD肺动脉压,有临床应用价值。

Objective： To investigate the clinical value of right ventricular myocardial isovolumic relaxation time in evaluating the pulmonary pressue in patients with left to right shunt congenital heart disease. Methods：Transthoracic echocardiography blood pool-derived IVRT （IVRTb） and PW mycardial-derived IVRT for the tricuspid valve annulus ring （IVRTm） were measured in sixty-one patients with left to right shunt congenital heart disease and thirty controls. IVRTb and IVRTm were corrected for heart rate and got IVRTcb and IVRTcm. The patients were underwent cardiac catheterization and pulmonary artery systolic pressure（PASP） and pulmonary artery mean pressure （PAMP） were obtained. Results： IVRTcb and IVRTcm were higher in patients with pulmonary artery hypertension（PAH） than in patients without PAH and normal subjects. IVRTcm and IVRTcb were significantly positive correlation with invasively measured PASP （ r =0.89, P 〈0.01; r=0.79, P〈0.01）. IVRTcm and IVRTeb were significantly positive correlation with invasively measured PAMP （ r =0.81, P〈0.01; r =0.72, P〈0.01）. IVRTcm had better sensitivity and specificity than IVRTcb for predicting PAH. IVRTcm〉63.5ms had a sensitivity of 90.3% and a specificity of 86.7% for predicting PAH. Conclusion：Right ventricular myocardial isovolumic relaxation time may be used as an assistant marker for estimaitng the PAH in patients with left to right shunt congenital heart disease.