肺动脉高压患者右心房容积和时相功能变化及其临床价值的研究

Study of the changing of right atrial volume and phasic function and its clinical value in patients with pulmonary hypertension

目的应用三维超声心动图探讨肺动脉高压患者右心房容积及各时相功能及其与临床的相关性。方法收集肺动脉高压患者50例，对照组20例。测量最大右心房容积（Vmin）、右心房收缩前容积（Vmin）、最小右心房容积（Vmin），计算右心房最大容积指数（VmaxI）、储器容积指数（TotEVI）、管道容积指数（PassEVI）、主动排空分数（ActEF），分析右心房VmaxI与右心室结构、功能及肺血流动力学参数之间的相关性。结果与对照组相比，WHO功能分级Ⅲ、Ⅳ级肺动脉高压患者右心房容积指数增大（均P〈0．01）。肺动脉高压组TotEVI升高（P〈0．001），PassEVI降低（P=0．11）；与对照组相比，WHO功能分级Ⅱ级的肺动脉高压患者ActEF变化差异无统计学意义（P=0．162），WHO功能分级Ⅲ级患者ActEF升高（P=0．008），而WHO功能分级Ⅳ级患者ActEF降低（P〈0．001）。右心房VmaxI与反映右心室结构参数、功能参数及右心室心指数有相关性（均P〈．05）。结论WHO功能分级Ⅲ、Ⅳ级肺动脉高压患者右心房容积指数增大。肺动脉高压患者储器功能增加，管道功能降低，主动收缩功能在WHO功能分级Ⅲ级患者中增加，wH0功能分级Ⅳ级患者中降低。右房主动收缩功能增加在代偿右室功能障碍中发挥重要作用。

Objective To evaluate the right atrial（RA） volume and phasic function using three- dimensional echocardiography（3DE）, and to examine the clinical relevance in pulmonary hypertension（PH）. Methods Fifty PH patients and 20 control subjects were studied. RA volume, including maximum RA volume （Vmax）, minimum RA volume （Vmin） and the volume before active systolic （VpreA） were evaluated by 3DE. RA maximum volume index （VmaxI）, total emptying volume index （TotEVI）, passive emptying volume index （PassEVI） and active ejection fraction （ActEF） were calculated. The correlation between RAVmaxI and the parameters of RV structure, function, pulmonary hemodynamics were analyzed. Results Maximum RA volume index （RAVmaxI） was higher in WHO functional class （WHO-FC） Ⅲ, Ⅳ of PH patients than in controls （all P 〈0.01）. TotEVI was significantly higher in PH patients than in controls （P〈0.001）, but PassEVI was lower in PH patients than in controls （P = 0.011）. ActEF was similar when comparing PH patients of WHO-FC Ⅱ with controls. ActEF increased in PH patients with WHO-FC Ⅲ as compared with controls （ P = 0.008） but reduced in advanced with WHO-FC IV patients （ P 〈0.001）. RAVmaxI correlated with the indices of right ventricular （RV） structure, function and RV cardiac output index （all P 〈0.05）. Conclusions PH is associated with increased RA size, increased TotEVI, and decreased PassEVI. ActEF increases in PH patients with WHO-FC Ⅲ but decreases in patients with WHO-FCIV. RA systolic function plays an important role in compensating RV dysfunction.