斑点追踪技术及三维超声心动图评价肺动脉高压患者右心房功能

Speckle tracking echocardiography and three-dimensional echocardiography in assessment of right atrial function of pulmonary hypertension patients

目的应用斑点追踪技术（STE）和三维超声心动图（3DE）分析肺动脉高压患者右心房各时相功能的变化,并探讨两者右心房功能参数的相关性。方法选取临床诊断为肺动脉高压且经胸超声心动图估测肺动脉收缩压（PASP）≥40mmHg者60例,按PASP分为：Ⅰ组（PASP为40~59mmHg,20例）,Ⅱ组（PASP为60~79mmHg,20例）和Ⅲ组（≥80mmHg,20例）,另选健康体检者30名作为对照组,行常规二维、三维超声心动图检查,脱机分析获得右心房相关应变和三维容积参数。结果右心房平均纵向应变值：随PASP的升高,负向峰值（LSneg）较对照组呈先增高后减低的趋势,正向峰值（LSpos）和总体纵向应变值（LStot））呈减低趋势。3DE参数：总排空分数指数（EFI）、被动排空分数指数（EFIpas）随PASP的升高呈减低趋势,主动排空分数指数（EFIact）随PASP的升高较对照组呈先增高后减低的趋势（P均〈0.05）。右心房排空容积指数（SVI）、主动排空容积指数（SVIact）、被动排空容积指数（SVIpas）随PASP的升高变化趋势不明显。相关性参数：LSneg与最小容积指数、LSpos与收缩前容积指数、LStot与EFI分别呈显著正相关（P均〈0.01）。结论 STE和3DE两种方法均能较客观地反应不同程度肺动脉高压患者右心房功能的变化,二者相关性良好,相互补充,对疾病的诊断、病情评估及预后判断更加敏感、准确。

Objective To investigate the effects of pulmonary hypertension on right atrial phasic function with speckle tracking echocardiography（STE）and three-dimensional echocardiography（3DE）,and to discuss the correlations between the right atrial function parameters of these two methods.Methods Sixty patients（case group）with clinical diagnosis of pulmonary hypertension and PASP≥40mmHg estimated by echocardiography were divided into 3groups：groupⅠ（PASP40—59mmHg,n=20）,group Ⅱ（PASP 60—79mmHg,n=20）and group Ⅲ（PASP≥80mmHg,n=20）.A total of30 healthy people were selected as control group.Conventional 2DE and 3DE were performed in all groups and the offline workstation was used to obtain the right atrial STE and 3DE parameters.Results Compared with the control group,the negative peak stain（LSneg）first raised and then dropped while the positive peak strain（LSpos）and total strain（LStot）kept dropping with PASP increasing in case groups（P〈0.05）.With the increasing of PASP in case group,the total empty fraction index（EFI）and passive empty fraction index（EFIpas）both dropped while active empty fraction index（EFIact）first raised and then dropped（P〈0.05）comparing with control group.The total stroke volume index（SVI）,passive stroke volume index（SVIpas）and active stroke volume index（SVIact）in case group showed no obvious change trend with PASP increasing.Significant positive correlations had shown between LSneg and minimal volume index,LSpos and presystolic volume index,LStot and EFI respectively（all P〈0.001）.Conclusion Both STE and 3DE can objectively estimate the change of right atrial function in PH patients,and they complement each other well to diagnose,evaluate and prognosis analysis of the disease.