右心室长轴运动的位移及速度在右心衰竭诊断中的价值

Diagnostic value of right ventricular longitudinal motion displacement and velocity in patients with right heart failure

目的:评价不同超声心动图指标和组合方式在右心衰竭中的诊断价值。方法:右心衰竭组患者62例,对照组健康成人52例,应用超声诊断仪测量三尖瓣环收缩位移(TAPSE)、收缩期峰值速度(Sm)、游离壁基底段应变(BS)、中间段应变(MS)、右心室舒张末期面积(RVEDA)和收缩末期面积(RVESA),计算右心室面积变化率。用逐步判别法分析结果,建立诊断右心衰竭的判别模型。分别用TAPSE<15mm、Sm<11.5cm/s及二者串联和并联试验4种方法诊断右心衰竭。结果:与对照组比较,右心衰竭组RVEDA和RVESA增加,TAPSE、Sm、BS和MS显著降低(均P<0.01)。诊断右心衰竭的判别模型:右心衰竭F=1.166×TAPSE+1.732×Sm-14.134,非右心衰竭F=1.779×TAPSE+2.627×Sm-31.818;两者串联时诊断灵敏度为90.3%,特异度为88.5%,正确率为89.5%。结论:诊断右心衰竭时,TAPSE与Sm更具价值,两者串联临床意义更大。

Objective：To evaluate the diagnostic value of different echocardiographic parameters and combination modes in patients with right heart failure. Method：A group of 62 patients suffering from right heart failure（RHF group） and 52 healthy controls（control group） were used echocardiography to measure tricuspid annulus systolic displacement（TAPSE）,tricuspid annular peak systolic velocity（Sm）,right ventricular end-diastolic area（RVEDA） and end-systolic area（RVESA）,right ventricular fractional area change,strain at basal segments（BS） and at middle segments（MS） of right ventricular free wall.We found out the parameters that play important roles in diagnosing right heart failure and establish the discriminant diagnosis model by stepwise discriminant analysis.The standard values used to diagnose right heart failure were TAPSE〈15 mm or Sm〈11.5 cm/s or combination of them. Result：Compared with control group,RVEDA and RVESA in RHF group were significantly increased,while TAPSE,Sm,BS and MS were significantly decreased（all P〈0.01）.The model of diagnosing right heart failure was： right heart failure F=1.166×TAPSE＋1.732×Sm-14.134,non-right heart failure F=1.779×TAPSE＋2.627×Sm-31.818.The sensitivity（90.3%） and specificity（88.5%） were high and accuracy rate（89.5%） was the best by combination in serial test. Conclusion：The diagnostic value of TAPSE and Sm in right heart failure was greater,and serial test of both offers potential diagnostic value.