二维斑点追踪成像技术评价慢性肺源性心脏病患者右室收缩功能的应用研究

Assessment of right ventricular systolic function in patients with chronic pulmonary heart disease using two-dimensional speckle tracking imaging

目的应用二维斑点追踪成像（2D—STI）技术测量慢性肺源性心脏病（CPHD）患者右室收缩功能指标，探讨所测各参数与心脏磁共振成像（CMRI）所测右室射血分数（RVEF）的相关性，并评价2D—STI在监测右室收缩功能中的应用价值。方法选取60例伴有三尖瓣反流的CPHD患者，测量三尖瓣反流峰值速度（Vmax），估测肺动脉收缩压（PAsP）。根据PASP严重程度分为轻度肺动脉高压（PH）组[30—50mmHg（1mmHg=0．133kPa）]和中重度PH组（PASP〉50mmHg）；另选30例健康志愿者作为对照组。对所有入选者行2D—STI及CMRI检查，2D—STI测量右室游离壁及室间隔（基底段、中间段、心尖段）纵向收缩峰值应变（Is）和纵向收缩峰值应变率（LSR），CMRI计算RVEF。将2D—STI所测参数与RVEF行相关分析。结果轻度PH组右室游离壁及室间隔各节段Ls均减低，右室游离壁心尖段及室间隔基底段LSR均减低，与对照组比较差异均有统计学意义（均P〈0．05）；而右室游离壁基底段、中间段及室间隔中间段、心尖段LSR与对照组比较差异无统计学意义。中重度PH组右室游离壁及室间隔各节段LS、LSR均减低，与对照组、轻度PH组比较差异均有统计学意义（均P〈0．05）。2D—STI所测各参数与CMRI所测RVEF呈正相关（P〈0．001）。结论2D-STI所测各参数与CMRI所测RVEF相关性良好，且能更准确地评估CPHD患者右室各节段的收缩功能，有望成为临床评价右室收缩功能的新方法。

Objective To measure the indexes of right ventricular systolic function in patients with chronic pulmonary heart disease （CPHD） using two-dimensional speckle tracking imaging（2D-STI）, explore the correlation between 2D-STI and cardiac magnetic resonance imaging（CMRI） for measuring right ventricular ejection fraction（RVEF） and evaluate the application value in monitoring right ventricular systolic function using 2D-STI. Methods Sixty CPHD patients with tricuspid regurgitation were selected. Peak velocity of tricuspid regurgitation（Vmax） was measured for calculating pulmonary arterial systolic pressure （PASP）. According to the severity of PASP,the patients were divided into two groups,including mild pulmonary hypertension （PH） group [30~50 mm Hg（1 mm Hg=0.133 kPa）] and moderate or severe PH group（PASP~〉50 mm Hg）. Thirty healthy volunteers were used as control group. All the subjects were examinated using 2D-STI and CMRI. Longitudinal peak systolic strain （LS） and longitudinal peak systolic strain rate （LSR） were measured in each segment of right ventricular free wall and interventricular septum using 2D-STI. RVEF was calculated using CMRI. The parameters of 2D-STI were compared with RVEF of CMRI using Pearson correlation test. Results LS in all segments of right ventricular free wall and interventricular septum in mild PH group were lower than those in control group（P〈0.05）. LSR in apical segment of right ventricular free wall and basal segment of interventricular septum in mild PH group were lower than those in control group（P〈0.05）. LSR in basal segment, middle segment of right ventricular free wall and middle segment and apical segment of interventricular septum were not significantly different from control group. Compared with control group and mild PH group,LS and LSR in all segments of right ventricular free wall and interventricular septum reduced in moderate or severe PH group（P〈0.05）. The parameters measured by 2D-STI were positively correlated with RVEF measured by CMRI（P〈0.001 ）. Conclusion Parameters measured by 2D-STI are positively correlate, d with RVEF measured by CMRI,which could assess accurately right Ventficular systolic function in patients with CPHD.Therefore,2D-STI will be expected to become a new method for clinical evaluation of right ventricular systolic functiorr