斑点追踪技术评价系统性红斑狼疮患者右心室收缩功能

Assessment of right ventricular systolic function with two-dimensional speckle tracking echocardiography in patients with systemic lupus erythematosus

目的采用斑点追踪成像(STE)技术评价系统性红斑狼疮(SLE)患者存在和不存在肺动脉高压(PAH)时右心室收缩功能。方法将65例SLE患者按照肺动脉收缩压(PASP)分为两组:SLE无PAH组35例(PASP<40mm Hg),SLE合并PAH组30例(PASP≥40mm Hg),并选择30例健康志愿者作为对照组。分别采集受试者常规超声心动图指标及三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期峰值速度(PSv)、右心室心肌做功指数(MPI)、肺血管阻力(PVR)和右心室射血效率(RVEe)。采用STE技术获得右心室游离壁及室间隔各节段峰值纵向收缩应变(LPSS)和右心室整体纵向应变(GLS)。分析上述指标在各组间的差异性及其之间的相关性。结果 3组间TAPSE、PSv、MPI、PVR和RVEe比较,差异均有统计学意义(均P<0.01)。SLE无PAH组与对照组比较,基底段、中间段和游离壁LPSS均减低(均P<0.05)。SLE合并PAH组与对照组比较,基底段、中间段、心尖段、游离壁、室间隔LPSS和GLS均减低(均P<0.05)。SLE合并PAH组与SLE无PAH组比较基底段、中间段、心尖段、游离壁、室间隔LPSS和GLS亦均减低(均P<0.05)。RVEe与PASP、PVR呈曲线关系,回归方程:RVEe=exp(1.35+29.44/PASP)(R^2=0.81,P<0.01),RVEe=exp(0.92+2.32/PVR)(R^2=0.90,P<0.01)。GLS与RVEe呈负相关(r=-0.708,P<0.01)。结论 STE技术可以定量评价SLE患者存在和不存在PAH时右心室收缩功能的变化,结合常规超声心动图,可简单、客观、有效评价PAH患者的右心室重构。

Objective To evaluate the right ventricular （RV） systolic function in systemic lupus erythematousus （SLE） patients with/without pulmonary arterial hypertension （PAH） by two-dimensional speckle tracking echocardiography （STE）.Methods Sixty five patients with SLE were divided into two groups according to the pulmonary arterial systolic pressure （PASP） measured by echocardiography：non-PAH group （PASP〈40 mm Hg,n=35） and PAH group （PASP ≥40 mm Hg,n=30）.Thirty healthy volunteers were enrolled as the controls.Routine echocardiographic parameters and tricuspid annular plane systolic excursion （TAPSE）,peak systolic velocity （PSv）,myocardial performance index （MPI）,pulmonary vascular resistance （PVR） and right ventricular ejection efficiency （RVEe） were measured and documented.Longitudinal peak systolic strain （LPSS） of the basal,middle,apical segments of the free wall of RV and interventricular septum and strains of the whole RV global longitudinal strain （GLS） were measured by STE.The differences were compared and the correlations were analyzed.Results There were significant differences of TAPSE,PSv,MPI,PVR,and RVEe among the three groups （all P〈0.01）.LPSS of the basal,middle segments,and the free wall of RV in non-PAH SLE patients were lower than those in control group （all P〈0.05）.LPSS of all segments of RV and GLS in PAH SLE patients significantly decreased compared to non-PAH SLE patients （all P〈0.05）.LPSS of all segments of RV and GLS in PAH SLE patients were lower than those in control group （all P〈0.05）.A power curve trend line fit the relationship between RVEe and PVR[RVEe=exp（0.92＋2.32/PVR）（R2=0.90,P〈0.01）] and between RVEe and PASP [RVEe=exp （1.35＋29.44/PASP）（R2=0.81,P〈0.01）].There was significant negative correlation between GLS and RVEe （r=-0.708,P〈0.01）.Conclusion Speckle tracking echocardiography can quantitatively assess right ventricular systolic function in SLE patients with/without PAH.Combined with routine echocardiography,it can simply,objectively and effectively evaluate the RA remodeling in SLE patients with PAH.