实时三维超声心动图评价终末期肾衰竭患者右心室整体及节段收缩功能

Evaluation of global and segmental systolic functions of right ventricle in end-stage renal failure patients by real-time three-dimensional echocardiography Sun Minmin , Pan Cuizhen , Kang Yu , Yao Haohua , Kong

目的采用实时三维超声心动图和四维右室定量分析技术评价慢性终末期肾衰竭患者的右室整体及节段收缩功能变化。方法采集48例终末期肾衰竭患者和26例正常对照者右室三维图像，测量右室整体及节段收缩功能参数，比较两组数据的差异。结果①与正常对照组相比，终末期肾衰竭患者的右室体部的舒张末容积、每搏输出量及射血分数均明显增大，差异有统计学意义[舒张末容积：（8．5±3．4）ml／m^2对（6．4±1．7）ml／m^2，P=0．002；每搏输出量：（4．5±1．7）ml／m^2对（2．7±0．9）ml／m。，P=0．0037；射血分数（45．4±11．5）％对（41．1±7．1）％，P=0．0489]，右室流人道部的舒张末容积、每搏输出量亦明显增大[（19．6±1．0）ml／m。对（16．5±0．9）ml／m^2，P=0．0438；（12．3±4．6）ml／m。对（10．1±3．2）ml／m^2，P=0．0433]。②终末期肾衰竭组的整体及节段达最小容积时间均较正常对照组显著延迟（均P＜0．001）。③与正常对照组相比，终末期肾衰竭组右室体部每搏输出量占整体百分比明显增大[（19．5±7．3）％对（15．5±5．5）％，P=0．0222]，而右室流出道部每搏输出量占整体百分比显著降低[（20．3±7．0）％对（26．8±8．2）％，P：0．00053]。结论慢性终末期。肾衰竭患者的右室收缩功能受损，且以右室体部变化最为显著；实时三维超声心动图可用于定量测量和评价肾衰竭患者的右室整体及节段收缩功能。

Objective To evaluate the global and segmental （inflow, body and outflow） systolic functions of right ventricle in end-stage renal failure （ESRF） patients by real-time three-dimensional echoeardiography（RT-3DE） and four-dimensional right ventricle quantitative analysis （4D-RVQ） and to reveal the long-term impact of renal insufficiency on right ventricular systolic function.Methods RT-3DE was performed in 48 ESRF patients and 26 healthy individuals （control group）.Images were acquired and analysed off-line in TomTec 4D-RVQ station. The parameters of RV global and segmental systolic functions,including RV global and segmental end-diastolic volume （EDV）, end-systolic volume（ESV）, stroke volume（SV） ,ejection fraction（EF）, the time to minimum systolic volume（T-rosy） were obtained.All the variables were standardized by body surface area（BSA） or heart rate（HR）.Results ①In the ESRF group,EDV,SV and EF of body compartment were significantly higher than those of the controls[EDV：（8.5±3.4）ml/m^2 vs （6.4 ±1.7）ml/m^2, P = 0.002;SV：（4.5± 1.7）ml/m^2 vs （2.7±0.9）ml/m^2, P = 0.0037 ; EF： （45.4±11.5） % vs （41.1±7.1 ）%, P = 0.0489], and so were EDV, SV of inflow compartment [EDV：（19.6±1.0）ml/m^2 vs （16.5±0.9）ml/m^2, P = 0.0438; SV： （12.3±4.6）ml/m^2 vs （10.1±3.2） ml/m^2, P = 0.0433].②Compared with the control group,the global and segmental T-msv were all delayed obviously in the ESRF group （P〈0.001）.③The percentage of SV of body compartment accounting for the global SV significantly increased in the ESRF group [（19.5±7.3）%0 vs （15.5±5.5）%, P = 0.0222], whilethat of outflow compartment reduced significantly [（20.3 ＋ 7.0）G vs （26.8 ＋ 8.2）%, P = 0.0005]. Conclusions The global and segmental systolic functions of right ventricle were impaired in ESRF patients, especially in the body compartment.The RT-3DE and 4D-RVQ are helpful technologies in the evaluation and follow-up of right ventricular systolic function in patients with renal failure.