二维应变超声心动图评价肺动脉高压患者右心整体及局部功能

目的采用传统超声心动图结合组织多普勒和二维斑点成像技术评价肺动脉高压患者右心室整体和局部收缩功能及其与临床WHO心功能分级的关系。方法纳入肺动脉高压患者25例和正常对照19例。采用常规超声心动图和二维应变分析软件对右心室心尖切面进行分析。测量右心室前壁和室间隔基底部、中部及心尖部心肌二维应变，并进行常规超声心动图测量。结果右心室6节段平均收缩应变比较，肺动脉高压组较对照组显著降低（P〈0．01）。WHO心功能分级与右心室6节段平均应变显著相关，心功能分级越高，6节段平均收缩应变的绝对值越小。结论在传统的多普勒超声心动图基础上结合基于斑点成像的二维应变技术综合评估肺动脉高压患者右心室整体和局部功能，对深入理解右心室病理状态下的改变、指导临床干预具有指导意义。

Objective To explore the feasibility of 2D strain echocardiography for the assessment of right ventricular （ RV ） global and regional systolic function and the correlation with clinical WHO heart function. Methods 25 patients with pulmonary arterial hypertension and 19 normal controls were studied. Echocardiographic right heart image in apical plane were analyzed by conventional manual tracing by 2D strain software. Myocardial strain was determined at the basal, mid and apical segments of the RV free wall and ventricular septum by 2D strain imaging, as well as conventional Doppler echocardiographic measurements. Results Although there are difference on M-mode, 2D and traditional Doppler echocardiographic parameters between PAH and controls, RV six segments average peak strain were significantly reduced in patients with pulmonary arterial hypertension compared with normal controls and were most altered in patients with the most severe clinical WHO function classification （ P〈0.01 ） . Conclusions Quantitation of global and regional RV function with angle-independent 2D strain as well as conventional Doppler echocardiography can be helpful to understand right heart change with pulmonary arterial hypertension and will be helpful for clinical treatment.