实时三维超声心动图评价肺动脉高压右心室收缩功能的临床研究

Evaluation of right ventricular function in patients with pulmonary arterial hypertension by real-time three dimensional echocardiography

目的应用实时三维超声心动图（RT-3DE）测量肺动脉高压（PH）患者右心室收缩功能，并与心脏磁共振测值作比较，评价RT-3DE测量右心室收缩功能的准确性。方法PH患者23例，常规超声测量三尖瓣环收缩期位移（TAPSE）、右室心肌做功指数（RIMP）、右室面积变化分数（RVFAC）及三尖瓣环收缩期峰值速度（S’）。RT-3DE测量右室舒张末期容积（RVEDV）、右室收缩末期容积（RVESV），得出右室射血分数（RVEF）。心脏磁共振测量右室舒张末期容积（MRI—RVEDV）及右室收缩末期容积（MRI—RVESV），计算右室射血分数（MRI-RVEF）。结果RT-3DE测量的RVEF与RVFAC呈显著正相关（r=0．595，P=0．003）；RVEF与RIMP呈显著负相关（r=-0．745，P=0．000），RVEF与TAPSE不具有相关性（r=-0．029，P=0．896），RVEF与S’呈正相关（r=0．489，P=0．018）。RT-3DE与心脏磁共振测量的RVEDV、RVESV及RVEF相关性好（均P〈0．001）；Bland—Altman图分析显示两种方法测量的RVEDV、RVESV及RVEF之间一致性良好。结论实时三维超声心动图能够无创、准确地评价肺动脉高压患者右室收缩功能，为临床评估PH患者预后及选择治疗方案提供依据。

Objective To evaluate right ventricular systolic function in patients with pulmonary hypertension （PH） by real-time three-dimensional echocardiography （RT-3DE）,and compared with cardiac magnetic resonance. Methods A total of 23 patients with PH who underwent MRI and echocardiography in the study. Right ventrieular index of myocardial performance （RIMP）, fractional area change （RVFAC）, tricuspid annular plane systolic excursion （TAPSE） and tissue Doppler-derived tricuspid lateral annular systolic velocity （S＇） were measured by echocardiography. RV end-diastolic volume （RVEDV） and end- systolic volume （RVESV） were measured by RT-3DE and cardiac magnetic resonance and RV ejection fraction （RVEF） was calculated. Results A positive correlation was found between RVFAC and RVEF （r = 0.595, P = 0.003）, there was a negative correlation between RIMP and RVEF （r = -0.745, P = 0.000）, has no correlation between TAPSE and RVEF （ r = - 0.029, P = 0.896）, a positive correlation was found between S＇ and RVEF （ r = 0.489, P = 0.018）. There were close correlation between RVEDV, RVESV and RVEF measured by RT-3DE and MRI （P 〈 0.001, respectively）; Bland-Altman analyses showed good agreement between them. Conclusions RT-3DE can noninvasive, accurate assessment right ventricular systolic function in patients with PH, and provide prognosis and treatment choice for clinical demands.