四维超声心动图对扩张型心肌病右室功能的诊断价值

The diagnostic value of four-dimensional echocardiography in right ventricular function with dilated cardiomyopathy

目的应用四维超声评价扩张型心肌病(DCM)右室收缩功能。方法以二维测量右室内径为基础,将73例DCM分为右室内径正常组(A组)39例,右室内径扩大组(B组)34例,另体检健康者36例为对照组。常规二维超声测量左室射血分数及各腔室大小,获取四维超声图,以三维斑点追踪成像测量右室心肌收缩期峰值应变,包括总体长轴峰值应变(GPSL)、总体圆周峰值应变(GPSC)、总体面积峰值应变(GPSA)及总体径向峰值应变(GPSR);建立四维右室模型测量右室容积和射血分数。DCM患者标准化治疗6个月后予复测上述参数。结果 B组右室容积大于A组及对照组(P<0.01)。对照组、A组、B组的左室舒张末期内径依次增大,左室、右室射血分数及右室心肌收缩期峰值应变均依次减小(均P<0.01)。GPSL、GPSC、GPSA及GPSR均与右室射血分数呈正相关,相关系数分别为0.84、0.69、0.85及0.87(P<0.01)。治疗后右室射血分数及右室心肌GPSL、GPSC及GPSR较治疗前提高(P<0.05)。结论 DCM患者右室收缩功能恶化先于腔室扩大,四维超声评价右室功能更为敏感。

Objective To evaluate the right ventricular systolic function in patients with dilated cardiomyopathy（DCM）by four-dimensional echocardiography. Methods Two-dimensional ultrasound was used to measure the right ventricular（RV）diameter, seventy-three cases with DCM were divided into normal diameter group（group A）of 39 cases and diameter enlargement group（group B） of 34 cases according to the right ventricular diameter, another 36 healthy cases were control group. The left ventricular ejection fraction（LVEF） and the size of each chamber were measured by conventional two- dimensional ultrasonography. Four-dimensional echocardiography were performed,the peak systolic strain（PSS） of RV myocardium was measured with three-dimensional speckle tracking imaging technique,which included global peak longitudinal strain（GPSL）,global peak circumferential strain（GPSC）,global peak area strain（GPSA） and global peak radial strain（GPSR）. Four-dimensional RV model was constructed and the volume and ejection function of RV were obtained. Four-dimensional echocardiography was performed again in all subjects after six months＇ standard treatment. Results The volume of RV in group B was larger than group A and control group, there was significant difference（P 0.01）. The left ventricular（LV）end diastolic diameter increased gradually in the control group, group A and group B while the ejection function of LV,RV and PSS of RV decreased gradually, there was significant difference（all P 0.01）. The GPSL, GPSC, GPSA and GPSR were all related to the systolic function of RV,the correlation coefficients were 0.84, 0.69, 0.85 and 0.87, respectively, there was significant difference（P 0.01）. The ejection function, GPSL,GPSC and GPSR of RV improved after treatment, there was difference（P 0.05）.Conclusion The deterioration of RV systolic function occurs earlier than the volume expansion in patients with DCM, and fourdimensional echocardiography is more sensitive in evaluating the RV function.