实时三维超声心动图对肺动脉高压患者右室功能的评价

Evaluation of right ventricular function in patients with pulmonary hypertension by real-time three-dimensional echocardiography

目的应用实时三维超声心动图(RT-3DE)评价肺动脉高压患者右室收缩功能。方法选取我院60例肺动脉高压患者,按照程度分为轻度组、中度组、重度组,每组各20例;另选健康成年人20例作为正常组对照。比较各组常规超声所测三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(RVFAC)、三尖瓣环收缩期峰值速度(S’)及右室心肌做功指数(RIMP),以及RT-3DE所测右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室每搏输出量(RVSV)及右室射血分数(RVEF)的差异;同时分析RVEF与常规参数之间的关系。结果随着肺动脉高压程度增加,TAPSE、S’及RVFAC测值降低,RIMP测值增加,且中度组与对照组和轻度组,以及重度组与正常组和轻度组比较差异均有统计学意义(均P<0.05);各组RVEDV比较差异无统计学意义,随着肺动脉高压程度越重,RVESV越大,RVSV及RVEF值越低;其中,除轻度组与正常组、中度组与重度组比较差异无统计学意义外,其余各组两两比较差异均有统计学意义(均P<0.05)。RVEF与TAPSE、RVFAC及S’均呈正相关(r=0.658、0.832、0.886,均P=0.000),与RIMP呈负相关(r=-0.759,P=0.000)。结论 RT-3DE能准确判断肺动脉高压患者右室收缩功能,对临床评价及预后判断有指导意义。

Objective To evaluate the right ventricular systolic function in patients with pulmonary hypertension（PH）by real-time three-dimensional echocardiography（RT-3DE）. Methods A total of 60 patients with PH were enrolled in this study,they were divided into mild group,moderate group and severe group according to pulmonary arterial pressure（PASP）level with 20 cases in each group. Another 20 healthy people were enrolled as control group. The conventional ultrasonic parameters of each group were measured including tricuspid annular plane systolic excursion（TAPSE）,right ventricular fractional area of change（RVFAC）,tricuspid lateral annular systolic velocity（S＇）and right ventricular index of myocardial performance（RIMP）. Then right ventricular end-diastolic volume（RVEDV）,right ventricular end-systolic volume（RVESV）,right ventricular stroke volume（RVSV）and right ventricular ejection fraction（RVEF） of each group were detected by RT-3DE. The differences of these parameters in two groups were compared and the relationship between RVEF and conventional parameters was analyzed. Results The measured values of TAPSE,S＇and RVFAC decreased while the RIMP test value increased with the increasing of pulmonary hypertension,there was significant difference between moderate group and control group and mild group,also there was difference between severe group and control group and mild group（all P〈0.05）. There was no significant difference of RVEDV among all the groups,the RVESVs were higher while RVSVs and RVEFs were lower with the increasing of the degree of PH. There were no significant differences between the mild group and the control group,and between the moderate group and severe groups,however,the differences between the other groups were statistically significant（all P〈0.05）. The positive correlation was found between RVEF and TAPSE,RVFAC as well as S＇（r=0.658,0.832,0.886,all P=0.000）,there were negative correlation between RVEF and RIMP（r=-0.759,P=0.000）. Conclusion RT-3DE can assess right ventricular systolic function in patients with PH accurately and provide guidance for clinical evaluation and prognosis judgement.