超声二维应变技术评价肺动脉高压患者右室收缩功能

Right Ventricular Function Assessed by Ultrasonic Two-dimensional Strain in Patients with Pulmonary Arterial Hypertension

目的应用传统超声二维模式测量肺动脉高压(pulmonary arterial hypertension,PAH)患者右室面积变化率及射血分数,并分析其与右室收缩期应变能力之间的相关性。使用二维应变软件定量分析PAH患者右室收缩期应变能力,并探讨不同程度肺动脉高压对右室收缩期峰值应变(S)及峰值应变率(SR)的影响。方法 PAH组[肺动脉收缩压(PASP)≥35mm Hg]分为3个亚组:轻度组24例,PASP35～45mm Hg;中度组22例,PASP46～59mm Hg;重度组19例,PASP≥60mm Hg。应用二维应变软件测量PAH患者和对照组的右室游离壁及室间隔各节段心肌收缩期峰值S、SR,记录并比较基底段、中段及心尖段的收缩期峰值S、SR在PAH组与对照组间有无差异,比较轻、中及重度PAH组间各测值有无差异。结果对照组EF值和面积变化率均高于PAH组(P<0.01),对照组右心房、右心室小于肺动脉高压组(P<0.01)。肺动脉高压患者的右室收缩期峰值S、SR低于正常人(P<0.01),随肺动脉高压程度的加重,右室收缩期峰值S、SR下降程度加重。射血分数与游离壁中段、基底段S在对照组和PAH组均高度相关(r=-0.604,P<0.001),与室间隔中段、基底段S在PAH组中有相关性,与游离壁基底段SR在PAH组高度相关(r=-0.603,P<0.001)。结论射血分数与收缩期峰值S及SR具有相关性,二维应变成像技术可作为独立指标来定量评价PAH患者右室局部收缩功能,为定量评估右室心肌功能提供一种新的方法。

Objective To assess the relationship between right ventricular RVPCA and ejection fraction （EF）, to estimate the right ventricular myocardium strain （S） and strain rate （SR） in patients with pulmonary hypertension using ultrasonic two-dimensional speckle tracking imaging （STI）, then discuss the effect of varying degrees of pulmonary hypertension on right ventricular peak systolic S and peak SR. Methods 65 patients with pulmonary arterial hypertension （PAH） were selected and divided into three groups by pulmonary arterial systolic pressure （PASP）. Mild group （PASP 35-45 mm Hg） included 24 patients, moderate group （PASP 46-59 mm Hg） included 22 patients, and severe group （PASP≥60 mm Hg） included 19 patients. Control group included 35 subjects. Peak myocardial systolic strain （S）, strain rate （SR） were measured respectively in right ventricular basal, mid and apical segments of free wall and ventricular septum in 65 patients with PAH and 35 normal subjects. The differences of S and SR between the PAH group and control group, and between three groups of patients were compared. Results Compared with the control group, the EF and RVPCA were significantly decreased while RA and RV were significantly increased in PAH group （P〈0.01）. SR of mid free wall were significantly reduced in three groups of patients compared with that in control group, and they were significantly decreased in severe group than that in mild and moderate groups （P〈0.01）. It was showed that SR was more sensitive than S.S and significantly reduced in PAH patients compare with normal subjects. EF was correlated with S of mid, basal free wall in control and PAH groups; EF was correlated with S of mid, basal IVS in PAH group; EF was correlated with SR of basal free wall in PAH group. Conclusion EF positively correlates with S and SR in PAH groups, Ultrasonic two-dimensional STI can quantitatively assess RV regional function, proving another useful modality for evaluating RV function.