超声心动图评价慢性肺动脉高压猪心室形态变化与肺动脉压的关系

Correlation Between Ventricular Morphologic Change and Pulmonary Arterial Pressure in a Swine Chronic Pulmonary Arterial Hypertension Model by Echocardiography

目的采用超声心动图评价慢性肺动脉高压猪心室形态变化,探讨其与肺动脉压的关系。材料与方法 36只小型巴马猪按完全随机区组设计法分为假手术组(6只)和实验组(30只)。实验组猪行颈动-静脉吻合术建立体-肺循环分流模型,假手术组除未行颈动-静脉吻合术外,其余外科手术操作步骤同实验组。术前及术后1年内每2个月行超声心动图检查观察三尖瓣反流(TR)、肺动脉瓣反流(PR),估测肺动脉收缩压(SPAP)及平均压(MPAP);计算右心室面积变化率(RVFAC)、收缩末期及舒张末期左心室偏心指数(LVEIs、LVEId),并分析RVFAC、LVEIs、LVEId与SPAP、MPAP的相关性。结果实验组建模成功15只,成模猪术后1年内,随时间推移,SPAP、MPAP逐渐升高,RVFAC逐渐减小,LVEIs、LVEId逐渐增大(P<0.05)。RVFAC与SPAP、MPAP呈负相关(r=-0.76、-0.69,P<0.01),LVEIs与SPAP、MPAP呈正相关(r=0.81、0.75,P<0.01),LVEId与SPAP、MPAP均无明显相关(r=0.26、0.23,P>0.05);假手术组不同时间点RVFAC、LVEIs、LVEId无显著差异(P>0.05)。结论颈动-静脉分流所致慢性肺动脉高压猪随肺动脉压升高,RVFAC逐渐减小,LVEIs逐渐增大,以RVFAC、LVEIs反映肺动脉压变化具有可行性。

Purpose To evaluate the morphologic change of left and right ventricles in a swine chronic pulmonary arterial hypertension （PAH） model using echocardiography and investigate its relationship with pulmonary arterial pressure. Materials and Methods Thirty-six mini Panama pigs were randomly divided into experimental （n=30） and control groups （n=30）. In the experimental group, the shunt from carotid artery to jugular vein was established, while the control group only had the same surgical procedure except tbr the shunting. Before and every two months after the operation, the tricuspid regurgitation and pulmonary regurgitation were monitored to estimate puhnonary arterial pressure （SPAP） and mean pulmonary arterial pressure （MPAP）. The right ventricular fractional area change （RVFAC）, left ventricular eccentricity index during end systolic and diastolic phase （LVEIs, LVEld） were calculated. Tile correlation between RVFAC, LVEIs, LVEId and SPAP, MPAP were analyzed. Results In the experimental group, 15 pigs survived. During the one-year observation, RVFAC decreased while LVEIs and LVEId increased gradually along with increasing SPAP, MPAP （P〈0.05）. RVFAC was correlated with SPAP, MPAP （r=0.76, -0.69, P〈0.01 ）. LVEIs was correlated with SPAP, MPAP （r=0.81, 0.75, P〈0.01）. There was no correlation between LVEld and SPAP, MPAP （r-0.26, 0.23, P〉0.05）. RVFAC, LVEIs, LVEIs had no statical differences in the control group （P〉0.05）. Conclusion In the swine mode of chronic pulmonary arterial hypertension with carotid artery-jugular vein shunt, RVFAC decreases while LVEIs increases gradually along with increasing pulmonary arterial pressure. The change of pulmonary arterial pressure can be monitored by RVFAC and LVEIs by echocardiography.