超声心动图与心脏核磁共振评估肺高血压患者右心室功能的比较

Association between echocardiography derived right ventricular function parameters with cardiac magnetic resonance derived right ventricular ejection fraction and 6-minute walk distance in pulmonary hypertension patients

目的 比较经胸超声心动图（TTE）评价肺高血压（PH）患者右心室功能的各指标与心脏核磁共振成像技术（CMR）测得的右心室射血分数（RVEF）及6 min步行距离（6MWD）的相关性.方法 入选天津医科大学总医院心血管内科2011年3月至2013年3月住院的Ⅰ类和Ⅳ类PH患者40例.入院后行右心导管（RHC）检查,确诊患者在病情稳定及治疗无变化1周内行CMR、TTE、6MWD试验.分别对CMR、TTE、6MWD指标进行相关性分析,并对TTE检测的各指标与CMR获得的RVEF（RVEF-CMR）的相关系数由大到小进行排序.结果 TTE评价右心室功能的指标中,游离壁三尖瓣环收缩期纵向收缩最大速度（S＇）、游离壁三尖瓣环收缩期峰值位移（TAPSE）、右心室面积变化分数（FAC）、游离壁三尖瓣环等容收缩期加速度（IVA）、心肌做功指数（MPI）与RVEF-CMR均存在相关性,相关系数依次是r =0.69（P ＜0.001）、r=0.65（P ＜0.001）、r=0.62（P ＜0.001）、r=0.43（P =0.006）和r=-0.38（P ＜0.05）.S ＇、TAPSE、FAC、IVA、MPI与6MWD无相关性.RVEF-CMR与6MWD无相关性.最准确指示RVEF-CMR≤20％的指标是S＇＜8.79 cm/s,ROC曲线下面积0.92（95％ CI：0.72 ～0.84）,敏感度0.91,特异度0.80.结论 S＇与RVEF相关性最强,S ＇＜8.79 cm/s能准确指示出RVEF≤20％的患者.RVEF-CMR、S ＇、TAPSE与6MWD均无相关性.

Objective To explore the association between transthoracic echocardiography （TFE） derived right ventricular （RV） function parameters with cardiovascular magnetic resonance imaging （CMR）derived RV ejection fraction （RVEF） and 6 minute walk distance （6MWD） in pulmonary hypertension （PH） patients.Methods A total of 40 PH patients （37 pulmonary artery hypertension （PAH） and 3 chronic thromboembolic pulmonary hypertension （CTEPH）） hospitalized in our department between March 2011 and March 2013 were enrolled in this study.PH diagnosis was established by right heart catheterization and TTE,CMR and 6MWT were performed within one week post TTE examination.TTE parameters included：tricuspid annular peak systolic excursion （TAPSE）,isovolumic contraction acceleration （IVA）,peak systolic velocity （S＇） at the lateral tricuspid annulus derived from tissue Doppler imaging,RV myocardial performance index （MPI） and RV fractional area change （FAC）.RVEF was obtained from CMR.Results S＇ （r=0.69,P〈0.001）,TAPSE （r=0.65,P〈0.001）,FAC （r =0.62,P〈0.001）,IVA （r =0.43,P =0.006）,MPI （r =-0.38,P 〈 0.05） correlated significantly with RVEF obtained from CMR.The best parameter to detect RVEF≤20% was S＇ 〈 8.79 cm/s（area under the ROC curve was 0.92 （95% CI：0.72-0.84）,sensitivity 0.91,and specificity 0.80）.No correlation was found between TTE parameters and 6MWD and between RVEF obtained from CMR and 6MWD.Conclusion S＇,derived from tissue Doppler imaging correlates best with RVEF obtained from CMR and may facilitate simple and quantitative assessment of RV function.The best parameter to detect RVEF≤20% is S＇ 〈 8.79 cm/s.