二维斑点追踪技术评价肺动脉压正常的慢性阻塞性肺疾病患者右心室功能研究

Evaluation of Right Ventricular Myocardial Function of COPD Patients With Normal Pulmonary Artery Pressure by 2D-STI

目的探讨二维斑点追踪技术(2D-STI)评估肺动脉压正常的慢性阻塞性肺疾病(COPD)患者右心室功能损害的价值。方法选取2012年4月—2013年4月于复旦大学附属金山医院治疗的肺动脉压正常的稳定期COPD患者60例(COPD组),另选取本院体检健康者40例为对照组。收集受试者性别、年龄、基础心率、体表面积等临床资料,记录心血管疾病史。采用GE Vivid 7超声诊断仪采集受试者平静呼吸时3个心动周期心尖四腔二维动态影像,记录常规超声参数。将动态影像导入Echo PAC工作站,应用2D-STI分析软件进行脱机分析,记录右心室游离壁基底部、中间部、心尖部及整体长轴应变。结果两组左心室射血分数(LVEF)、肺动脉收缩压(PASP)、右心室舒张期内径(RVDd)、右心室收缩期内径(RVDs)、右心室射血分数(RVEF)、右心室面积变化分数(RVFAC)、E峰、E/A比值、E峰减速时间(DT)、右房室瓣环运动速度(e')、E/e'及右心室Tei指数比较,差异均无统计学意义(P>0.05)。而两组右心室壁厚度(RVWH)和A峰比较,差异有统计学意义(P<0.05)。COPD组右心室游离壁基底部、中间部、心尖部及整体长轴应变功能均低于对照组,差异有统计学意义(P<0.05)。结论肺动脉压正常的COPD患者右心室长轴应变功能已经开始减弱,2D-STI可早期发现其右心室功能的轻微改变。

Objective To investigate the value of two- dimensional speckle tracking imaging（ 2D- STI） in the assessment of right ventricular myocardial function impairment in patients with chronic obstructive pulmonary disease（ COPD） and normal pulmonary artery pressure. Methods We enrolled 60 COPD patients in stable phrase and with normal pulmonary artery pressure who received treatment in Jinshan Hospital,Fudan University from April 2012 to April 2013 as COPD group,and we enrolled another 40 healther from this hospital as control group. We collected clinical data of the subjects,such as gender,age,basic heart rate and body surface area,and recorded the history of cardiovascular disease. GE Vivid 7 diasonograph was used to obtain the two- dimensional dynamic images of apical four chamber for three cardiac cycles when the subjects were in eupnoea,and the conventional ultrasound parameters were recorded. The dynamic images were imported into Echo PAC,and offline analysis was conducted using 2D- STI analysis software; meantime,the right ventricular longitudinal strains（ LS） of basal,middle,apical and whole levels were measured. Results The two groups were not significantly different（ P 〉0. 05） in LVEF,PASP,RVDd,RVDs, RVEF, RVFAC, E peak, E / A, DT, e＇、 E / e＇ and Tei index of right ventricle. The two groups were significantly different（ P 〈0. 05） in RVWH and A peak. COPD group was lower（ P 〈0. 05） than control group in right ventricular LS of basal,middle,apical and global levels. Conclusion COPD patients with normal pulmonary artery pressurealready have impaired right ventricular function. The slight changes of right ventricular myocardial function could be detected in the early stage of COPD by 2D- STI.