超声心动图评估右冠状动脉慢性完全闭塞病变患者右心功能的临床价值

Evaluation of right ventricular function in patients with right coronary artery chronic total occlusion

目的:应用超声心动图评估右冠状动脉(RCA)慢性完全性闭塞(CTO)病变患者右心功能的变化情况。方法:入选首都医科大学附属北京安贞医院2013年12月至2015年12月,收治的RCACTO患者25例,根据冠状动脉造影结果分为侧枝循环良好组和侧枝循环不良组,应用超声心动图测量两组右心室收缩末面积(RVEDA)、右心室舒张末面积(RVESA)、右心室面积变化率(RVFAC)、三尖瓣环收缩期位移(TAPSE)、心肌综合指数(MPI)、多普勒超声心动图测量三尖瓣口舒张期血流速度(E、A峰值)、组织多普勒(TDI)测量三尖瓣环舒张期运动速度(e‘及a’值),结果:MPI与TAPSE及RVFAC呈负相关,与E/A比值及E/e’比值呈正相关。与侧枝循环良好组比较,侧枝循环不良组RVFAC、TAPSE较低,MPI、E/A比值及E/e’比值较高。结论:RCA-CTO患者右心功能会发生变化,侧枝循环形成不良较侧枝循环形成良好者右心功能下降明显,术前二维超声心动图检查对此类患者右心功能的评估具有一定的临床意义。

Objective ： To investigate the changes of right ventricular function in patients with right coronary artery chronic total occlusion（RCA-CTO）. Methods： We studied 25 consecutive patients with RCA-CTO in Beijing Anzhen hospital from December 2013 to December 2015. The patients were divided into the coronary Collateral cirulation（CCC） group and non-CCC group according to the results of coronary angiography. Echocardiography was performed in order to measure the RV fractional area change （ RVFAC ） , tricuspid annular plane systolic excursion（TAPSE）, myocardial performance index （MPI）,trans-tricuspid E and A waves, E/A ratio, e＇ and a＇ Results ： MPI showed negative correlation with TAPSE and RVFAC, positive correlation with trans-tricuspid E/A ratio and E/e＇ ratio. Patients in the non-CCC group had lower TAPSE and RVFAC and a higher MPI, E/A ratio and E/e＇ ratio. Conclusion：RCA-CTO patients with decreased right ventricular function. Patients with the poorly developed coronary collaterals have worse RV functions.