应变和应变率成像对慢性阻塞性肺病患者右室收缩功能的评价

Evaluation of right ventricular systolic function in patients with chronic obstructive pulmonary disease by strain and strain rate imaging

目的探讨应变和应变率成像评估慢性阻塞性肺病(COPD)患者右室心肌收缩功能的价值。方法根据肺动脉收缩压将38例COPD患者分为肺动脉高压组(病例组Ⅰ)和无肺动脉高压组(病例组Ⅱ),同期正常对照组为18例健康体检者。使用M型超声和常规超声测量右室前壁舒张末期厚度(RVFT)、右室舒张末期内径(RVEDd)、三尖瓣环收缩期位移(TAPSE)、右室舒张末期面积(RVEDa)及右室收缩末期面积(RVESa),计算右室面积变化分数(RVFA)。采用应变和应变率分析软件检测右室游离壁和室间隔各节段的收缩期峰值应变(Ss)和收缩期峰值应变率(SRs)。结果与正常对照组比较,病例组Ⅰ的RVFT增厚,RVEDd明显增大,RAFA和TAPSE明显减小(P<0.05),病例组Ⅱ的上述参数与正常对照组比较差异无统计学意义(P>0.05)。病例组Ⅰ右室游离壁、室间隔基底段、中间段的Ss和SRs均显著低于病例组Ⅱ和正常对照组(P<0.05),病例组Ⅱ的右室游离壁基底段的Ss和SRs均显著低于正常对照组(P<0.05)。结论应变和应变率成像能有效检出COPD患者早期右室局部心肌收缩功能变化,以右室游离壁基底段Ss与SRs的变化较为敏感。

Objective To explore the values of strain and strain rate imaging techniques for evaluating right ventricular systolic functions in patients with chronic obstructive pulmonary disease （COPD） . Methods Thirty - eight patients with COPD and eighteen normal subjects were enrolled in this study. According the pulmonary artery systolic pressure, thirty - eight patients with COPD were divided into pulmonary artery hypertension group （ group I ） and non - pulmonary artery hypertension group （group H ）. The right ventrieular frontal thickness （RVFT） , right ventrieular end diastolic diameter （RVEDd）, tricuspid annular plane systolic excursion（TAPSE）, fight ventricular end diastolic area（RVEDa） and fight ventricular end systolic area （RVESa） were measured by M mode ultrasound and conventional ultrasound, the fraction of right ventficular area change （RVFA） were calculated. The peak systolic strain （Ss） and peak systolic strain rate （SRs） were measured at each segment of fight ventricular free walls and interventricular septums by strain and strain rate quantitative analysis soft - ware. Results Compared with normal control group, RVFT and RVEDd increased in group I , RVFA and TAPSE decreased （ P 〈 0.05 ）, while there was no significant difference of right ventficular parameters between group H and normal control group （ P 〉 0.05 ）. Ss and SRs in basal and mid segments of fight ventricular free wall and interventfieular septums in group I were significantly lower than those in group II and normal controls （ P 〈 0.05 ）. Ss and SRs in basal segments of right ventricular free wall in group 11 were significantly lower than those in normal control group （ P 〈 0.05 ）. Conclusion Strain and strain rate imaging can reflect the early change of regional myocardial systolic functions of right ventricle wall in patients with COPD, while systolic Ss and SRs in the basal segment of fight ventricular free wall is more sensitive.