实时三维超声心动图定量评价风湿性二尖瓣狭窄患者的右心室功能

Assessment of global and regional right ventricular function of patients with rheumatic mitral stenosis by real-time three-dimensional echocardiography

目的应用实时三维超声心动图(RT-3DE)技术评价风湿性二尖瓣狭窄(MS)患者右心室整体及局部容积与功能。方法 41例MS患者分为A组18例,轻度三尖瓣反流;B组23例,中度及中度以上三尖瓣反流。应用四维右心室定量分析法(4D-RVQ)测量41例MS患者和25例正常对照者右心室整体及局部舒张末期容积、收缩末期容积及射血分数。结果与正常对照组和A组相比,B组的右心室整体和局部舒张末和收缩末容积均增大,差异均有统计学意义(均P<0.01)。A组和B组的右心室整体射血分数较正常对照组降低,差异有统计学意义(P<0.01)。在右心室局部收缩功能的比较中,A组和B组的流入道和流出道的射血分数降低,而且B组流入道收缩功能较A组进一步降低,差异具有统计学意义(P<0.01)。而心尖肌小梁部收缩功能差异没有统计学意义。结论 RT-3DE可以定量评价MS患者右心室整体及局部容积与收缩功能。三尖瓣反流程度影响右心室整体及局部收缩功能。

Objective To assess the global and regional right ventricular volume and function in rheumatic mitral stenosis（MS）patients using real-time three-dimensional echocardiography（RT-3DE）.Methods Forty-one patients with MS and twenty-five normal controls were studied.MS patients were divided into mild tricuspid regurgitation（group A）and moderate or severe tricuspid regurgitation（group B）.RT-3DE was performed by Philips IE33 with a X3-1 probe.Right ventricular volume parameters were offline assessed by Tem Tec 4D right ventricular function software.Results Compared with the group A and the controls,global and regional right ventricular end diastolic and systolic volume were higher in the group B（P0.01）.Global right ventricular ejection fraction of the group A and group B were lower than that of the control group（P0.01）.In the comparison of regional right ventricular function,the ejection fraction of inflow and outflow in MS patients were lower than that in the control group.With the tricuspid regurgitation increased,the ejection fraction of inflow further decreased（P0.01）.However,the ejection fraction of trabeculated apical myocardium didn＇t show evident difference during the three groups.Conclusions RT-3DE provides a fast,convenient,non-invasive technique to evaluate global and regional right ventricular volume and function in patients with MS.Regional right ventricular systolic function can be affected by tricuspid regurgitation.