二维斑点追踪技术评估肺动脉高压患者右心房形变与心功能评级的关系

The correlation of right heart functional classification with right atrial deformation in patients with pulmonary arterial hypertension： a study with two-dimensional speckle tracking imaging

目的探讨二维斑点追踪技术评估肺动脉高压患者右房心肌功能的临床价值，并明确右房功能和心功能评级的关系。方法选择38例肺动脉高压患者和25例相匹配的健康志愿者，应用二维斑点追踪技术测量右房心肌纵向应变（PALS）和应变率（SR）。PALS为心尖四腔观测量的右房心肌所有节段的平均值。结果与对照组相比，啼动脉高压患者右房PALS明显降低，而且随心功能不全的进展逐渐降低。右房PALS与6min步行距离呈正相关。右房PALS〈38．08％在预测患者心功能状态方面表现出非常高的诊断准确率（ROC曲线下面积0．979），其敏感性和特异性分别为86．8％、84．0％。结论肺动脉高压患者右房形变显著受损。运用二：维斑点追踪技术可评估右房储器功能，右房PALS可以预测肺动脉高压患者心功能状态和活动耐力。

Objective To asse,;s right atrial （RA） myocardial mechanics in pulmonary hypertension （PH） patients using two-dimensional speckle tracking imaging （2D-STI）, and define the relationship between RA function and exercise capacity in PH patients. Methods Thirty-eight consecutive PH patients were studied and compared with a control group of 25 healthy volunteers. Peak atrial longitudinal strain （PALS） and strain rate of RA were measured in all subjects. PALS values were obtained by averaging all segments （global PALS） measured in the 4-chamber view. Results RA PALS was significantly lower in PH patients than in controls, and gradually reduced with the development of cardiac insufficiency. A significantly postive correlation between global PALS and 6-minute walk distance was found（ P = 0.003）. Furthermore,global PALS demonstrated the highest diagnositic accuracy （AUC of 0.979） and excellent sensitivity and specificity of 86.8 % and 84.0 %, respectively, to predict functional status using a cutoff value less than 38.08%. Conclusions RA deformation is significantly damaged in PH patients. RA reservoir function can be estimated using 213-STI, and gradually decrease in PH patients with different WHO- functional class （WHO-FC）. RA PALS is a powerful predictor of cardiac functional status and exercise capacity in PH patients.