实时三维超声心动图评估射血分数减低的左心力衰竭患者的右心室重构

Assessing right ventricular remodeling in left heart failure patients with reduced ejection fraction with real-time three-dimensional echocardiography

目的采用单心动周期实时三维超声心动图(sRT-3DE)结合传统二维超声心动图探讨左心室射血分数(LVEF)减低的左心力衰竭患者肺高压(PH)对右心室重构的影响。方法对sRT-3DE检查LVEF<50%的60例患者(病例组)根据肺动脉收缩压(PASP)及肺血管阻力(PVR)不同分为3个亚组:HF-NPH亚组15例,HF-PPH亚组15例,HF-RPH亚组30例,正常健康人35名为对照组。对两组行常规二维超声及sRT-3DE检查,分析获得三维、二维及多普勒超声参数,进行组间对比分析和相关性分析。结果与对照组比较:病例组右心室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、基底部横径(D1)、长径(LD)、D1/中间横部径(D2)、射血分数(EF)减小。与HF-NPH亚组比较,HF-PPH亚组右心室ESVI、D1/D2、LD/D2增大。与HF-PPH亚组比较,HF-RPH亚组右心室EDVI、ESVI、D2增大,右心室EF、LD/D2减低。PVR与PASP、右心室EF与左心室EF、右心室LD与左心室LD呈正相关性(r=0.765、0.628、0.725;P均<0.01),PVR与右心室EF呈负相关(r=-0.715,P<0.01),且高于与PASP的相关性(r=-0.623,P<0.01)。结论 sRT-3DE结合传统二维及多普勒超声可准确评估左心力衰竭患者的右心室重构,有助于判断右心室结构和功能状态。

Objective To assess the influence of pulmonary hypertension （PH） on right ventricular remodeling in left heart failure patients with single reduced ejection fraction with cardiac cycle real-time three-dimensional echocardiography （sRT-3DE） combined with conventional two-dimensional （2DE） and Doppler echocardiography. Methods Totally 60 pa- tients （case group） with LVEF〈50% measured by sRT-3DE were divided into three subgroups by pulmonary arterial sys- tolic pressure （PASP） and pulmonary vascular resistance （PVR） ： 15 patients in HF-NPH subgroup, 15 patients in HF- PPH subgroup and 30 patients in HF-RPH subgroup. Thirty-five healthy people were selected as control group. The 2DE and sRT-3DE were performed in all groups to analyze the 2DE, sRT-3DE and Doppler parameters, which were compared statistically and the correlation analysis was performed. Results Compared with the control group, the right ventricular end-diastolic volume index （EDVI）, end-systolic volume index （ESVI）, diameter of based （D1）, long diameter （LD）, D1/ diameter intermediate portion （D2） increased and ejection fraction （EF） decreased in case group. Compared with HF-NPH subgroup, right ventricular ESVI, D1/D2 and LD/D2 increased in HF PPH subgroup. In HF-RPH subgroup, the right ventricular EDVI, ESVI, D2 increased and right ventricular EF, LD/D2 decreased compared with the HF-PPH subgroup. PVR and PASP, right ventricular and left ventricular EF, right ventricular and left ventricular LD had positive correlation （r=0.765, 0.628, 0.725, all P〈0.01）, PVR and right ventricular EF was negatively correlated （r=-0.7l5, P 0.01）, which was higher than with the PASP correlation （r=-0. 623, P〈0.01）. Conclusion sRT-3DE combined with the traditional 2DE and Doppler echocardiography can accurately assess the right ventricular remodeling in patients with left heart failure and reflect the state of the right ventricular structure and function.