二维斑点追踪成像评价急性肺栓塞患者右室整体心肌功能改变

Evaluation of right ventricular global myocardial function in patients with acute pulmonary embolism by two-dimensional speckle tracking imaging

目的应用二维斑点追踪成像(2D-STI)评价急性肺栓塞(APE)患者右室整体心肌功能改变及其影响因素。方法 APE患者40例为APE组,体检健康者40例为对照组。超声于心尖四腔及大动脉短轴切面测量右室舒张末横径(RVEDD)、肺动脉主干内径(MPA)、肺动脉瓣收缩期的峰值流速(PV峰速)、射血时间(ET)、射流加速时间(Ac T)及射流减速时间(DT)。连续多普勒测量三尖瓣反流最大压差,以右房大小和下腔静脉塌陷指数评估右房压,三尖瓣反流最大压差与右房压之和为肺动脉收缩压(PASP)。应用双平面Simpson法计算右室射血分数(RVEF)。STI测量右室整体纵向的收缩期峰值应变(GLS)、收缩期峰值应变率(GLSRs)、舒张早期峰值应变率(GLSRe)、舒张晚峰值应变率(GLSRa),计算GLSRe/GLSRa。结果 1与对照组比较,APE组RVEDD、MPA、PASP增大,Ac T、RVEF减小(均P<0.05)。2APE组右室GLS、GLSRs、GLSRe、GLSRe/GLSRa较对照组均减低(均P<0.05);3PASP是影响APE患者右室GLS和GLSRs的决定因素(r值分别为-0.399、-0.433,P<0.05)。结论 APE患者右室整体收缩及舒张功能均下降,PASP是影响APE患者右室整体心肌功能的决定因素。2D-STI可以有效评价APE患者右室整体心肌功能改变。

Objective To evaluate the right ventricular global myocardial function in patients with acute pulmonary embolism （APE） by two-dimensional speckle tracking imaging （2D-STI）. Methods Forty patients with APE and 40 controls were enrolled in the study.The measurement of right ventricular end diastolic diameter（RVEDD）,main pulmonary artery diameter （MPA）, pulmonary valve peak systolic velocity（PV peak velocity）, pulmonary valve systolic ejection time（ET）, pulmonary valve systolic acceleration time （ACT） and pulmonary valve systolic deceleration time （DT） were implemented from the apical fourchamber and great artery short-axis views.The maximum differential pressure of tricuspid regurgitation was evaluated by continuous Doppler.The right atrial pressure was assessed by the size of right atrial and the collapse index of the inferior vena cava,and the pulmonary arterial systolic pressure（PASP） was equivalent to the sum of right atrial pressure and the maximum differential pressure of tricuspid regurgitation. The right ventricular ejection fraction（RVEF） was calculated by double plane Simpson method. Global longitudinal peak systolic strain（GLS）, Global longitudinal peak systolic strain rate（GLSRs）, Global longitudinal peak early diastolic strain rate（GLSRe）, Global longitudinal peak early diastolic strain rate/peak late diastolic strain rate（GLSRe/GLSRa） were measured by 2D-STI. Results ①Compared with controls,the RVEDD was enlarged,the MPA was expanded,the PASP was increased,the AcT was shortened, and the RVEF was reduced in patients with APE （all P〈0.05）. ②Compared with controls, RV GLS, GLSRs, GLSRe and GLSRe/GLSRa were significantly reduced in patients with APE （P〈0.05）. ③PASP was significant correlated with RV GLS and GLSRs（r=-0.399,-0.433 ,P〈0.05）. Conclusion Both RV global systolic and diastolic function decrease in patients with APE. PASP is the main factor affecting RV global function. 2D-STI is a new method to evaluate RV global myocardial function in patients with APE.