X-Strain技术在评估肺高压患者右心室收缩功能中的作用

The X-strain technology in evaluating right ventricular systolic function in patients with pulmonary hypertension

目的探讨速度矢量成像(X-Strain)技术评价不同程度肺高压(PH)患者的右心室收缩功能及临床意义。方法选取60例PH患者(sPAP≥40mmHg,1mmHg=0.133KPa),根据肺动脉收缩压(sPAP)严重程度将其分为轻度PH组及中重度PH组,同期选取年龄、性别与之相匹配的健康体检者30例作为对照组。获得舒张末期右心室前壁厚度(RVAW)、右心室横径(RVD)、右心房横径(RAD)、收缩末期肺动脉主干内径(MPA),右心室室壁各节段纵向收缩期峰值应变(LS)、应变率(LSR),将各参数行组间比较,统计学方法采用单因素方差分析。结果中重度PH组RVAW、RVED、RAD、MPA较对照组及轻度PH组均减低,差异有统计学意义(P<0.05),轻度PH组与对照组之间差异无统计学意义(P>0.05),轻度及中重度PH组右心室室壁各节段LS较对照组均减低,差异有统计学意义(P<0.05),中重度PH组右心室室壁各节段LS较轻度组减低,差异有统计学意义(P<0.05),中重度PH组右心室室壁各节段LSR较对照组及轻度PH组均减低,差异有统计学意义(P<0.05),轻度PH组仅右心室游离壁及室间隔心尖段LSR较对照组减低,差异有统计学意义(P<0.05),轻度PH组右室壁基底段、中间段LSR较对照组均无统计学意义(P>0.05)。结论PH患者右心室室壁各节段收缩功能依照PH分级有不同程度的损害,X-Strain技术可定量评价右心室局部收缩功能,在整体右心室功能出现改变之前敏感反映右心室各节段收缩功能的变化,为临床早期干预治疗提供准确的依据。

Objective To investigate the velocity vector imaging （X-Strain） technique in evaluating right ventricular sys- tolic function and its clinical significance in patients of different degrees of pulmonary hypertension （PH）. Methods We chose 60 cases of PH patients （sPAP=40 mmHg, 1 mmHg=0. 133 kPa）, which be divided into mild PH group and se- vere PH group according to the pulmonary artery systolic pressure （sPAP） severity, at the same period, 30 control sub- jects were recruited. We get the right ventricular anterior wall thickness at end diastole （RVAW）, right ventricular diame- ter （RVD）, right atrial diameter （RAD）, pulmonary artery diameter （MPA） at end systolic, right ventricular wall seg- ments of longitudinal peak systolic strain （LS）, longitudinal peak systolic strain rate （LSR）, and then, the parameters be- tween groups were compared by one-way analysis of variance （ANOVA）. Results In severe PH group, RVAW, RVED, RAD, MPA were lower than the control group and the mild PH group （ P 〈0.05）, while these parameters were no sta- tistically significant difference between the mild PH group and the control group （ P 〉0.05）. The LS in mild and severe PH group of right ventricular wall segments were less lower than the control group （ P 〈0.05）, in severe PH group, the LS of right ventricular wall segments decreased than the mild group （ P 〈0.05）, in severe PH group, right ventricular wall segments of LSR were lower than the control group and the mild PH group （ P 〈0.05）, the LSR of mild PH group only apical septal of right ventricular free wall and ventrieular septal lower than the control group （ P 〈0.05）, the mild PH group right ventricular wall in basal, middle section of LSR than in the control group had no statistical significance （ P 〉0.05）. Conclusion X-Strain technology can quantitatively evaluate regional systolic function of right ventrieular, sensi- tively reflect the changes of each segment of right ventricular systolic function before a change in the overall right ventricu- lar function, which can provide the accurate basis for the clinical treatment of early intervention.