速度向量成像联合等长负荷试验评价肝硬化右心室收缩期心肌力学功能

Evaluation of regional myocardial mechanics of right ventricle in patients with liver cirrhosis using velocity vector imaging combined with isometric stress test

目的 应用超声速度向量成像（velocity vector imaging,VVI）技术评价不同阶段肝硬化右心室心肌力学功能状态;联合标准等长握力试验,进一步揭示早期肝硬化等长负荷前后右心室心肌力学功能变化,探索肝硬化性心肌病超声心动图早期诊断的方法和指标.方法 肝硬化患者82例,根据Child-Pugh评分分为3组：A组（42例）、B组（28例）、C组（12例）,其中A组中31例进行标准等长握力试验.对照组34例.采集连续三个心动周期的心尖四腔观右心室长轴切面,运用VVI图像工作站获取右心室6个节段心肌收缩期纵向峰值应变（Smax）及整体射血分数（RVEF）.结果 ①肝硬化组与对照组比较,A组RVEF正常,右心室各节段Smax无明显变化（P＞0.05）;B组RVEF无明显改变（P＞0.05）,右心室各节段Smax增大为主（P＜0.05～0.01）;C组RVEF明显减低（P＜0.01）,右心室各节段心肌Smax减低为主（P ＜0.05～0.01）.②肝硬化组组间比较：A、B组间血压、RVEF、右心室各节段Smax差异无统计学意义（P＞0.05）;与A组比较,C组血压及RVEF显著下降;右心室各节段Smax以减低为主（P＜0.05～0.01）;与B组比较,C组血压及RVEF显著降低;右心室各节段Smax明显减低（P＜0.01）.③与静息状态相比,标准等长握力试验后A组RVEF明显降低,右心室各节段Smax明显减低（P＜0.05～0.01）.结论 等长负荷实验有助于揭示肝硬化早期患者右心室心肌功能损伤;肝硬化病情程度不同,右室心肌收缩功能存在明显差异.

Objective To study regional myocardial function of right ventricle at different stages of cirrhosis,using velocity vector imaging combined with standard isometric grip strength test to reveal the mechanical function in patients with liver cirrhosis at early stage further,and to benefit reliable quantitative evaluation and efficacy indicators for the establishment of the early diagnostic criteria of cirrhotic cardiomyopathy by echocardiography,and found myocardial mechanics basis for explicit pathogenesis of cirrhotic cardiomyopathy.Methods Accorded to Child-Pugh score,the cirrhosis experimental groups were divided into three groups：group A （42 patients）,group B （28 patients） and group C （12 patients）.There were 31 patients in group A to be conducted standard isometric grip strength test.While 34 healthy people were selected as the control group.The dynamic gray scale long-axis view images of the right ventricle were collected in 3 complete cardiac cycles in apical four-chamber view.Peak systolic longitudinal strain （Smax） and global ejection fraction of the right ventricle were derived from 6 myocardial segments with the Syngo VVI workstation off-line.Results 1）Compared with the control group,in group A,global ejection fraction of the right ventricle was normal,there were not significant change of Smax of each segment （P ＞0.05）.In group B,there was not significant change of global ejection fraction of the right ventricle,the Smax of each segment were increased mainly （P ＜0.05-0.01）.In group C,global ejection fraction of the right ventricle was significantly lower （P ＜ 0.01）,the Smax of each segment reduced mainly （P ＜ 0.05-0.01）.2）Compared with group A,in group B,there was no significant difference of blood pressure and global ejection fraction of the right ventricle,while including the Smax of each segment in systole and diastole.Compared with group A and group B,in group C,systolic and diastolic blood pressure and global ejection fraction of the right ventricle decreased significantly; the Smax of each segment were reduced mainly （P ＜ 0.05-0.01）.3）Compared with the resting state,after the standard isometric grip strength test,the global ejection fraction of the right ventricle decreased significantly,there was a significant reduction mainly in Smax of each segment （P ＜ 0.01）.Conclusions The regional myocardial function of right ventricle in patients with liver cirrhosis is abnormality even at early stage and could be revealed by standard isometric stress test.The right ventricular systolic dyfunction is related to the stages of liver cirrhosis disease.