右室长轴应变与传统超声指标评价慢性血栓栓塞性肺动脉高压右心功能不全的比较研究

Echocardiographic study of right ventricular dysfunction in patients with chronic thromboembolic pulmonary hypertension： Comparison of the right ventricular free wall longitudinal strain and conventional parameters

目的探讨右室游离壁长轴应变（FwLs）和传统右心功能指标在评价慢性血栓栓塞性肺动脉高压（CTEPH）右心功能不全中的价值。方法选取CTEPH患者60例为A组，肺动脉压力正常的肺血栓栓塞症（PE）患者45例为B组。A组根据wHO心功能分级分为两个亚组：心功能Ⅰ～Ⅱ级为A1组，心功能Ⅲ～Ⅳ级为A2组。比较A组与B组、A1与A2组的传统右心功能指标[三尖瓣环收缩期位移（TAPsE）、组织多普勒二尖瓣环收缩期峰值速度（Sf）、右室面积变化率（FAc）、右室心肌做功指数（RVIMP）]及右室FWLS，比较各右心功能指标诊断右心衰竭的曲线下面积。应用二分类Logistic回归分析研究各指标预测右心衰竭的价值。结果与B组相比，A组患者右心显著扩大，常规右心功能指标及右室FWLS均明显受损（P〈0．001）。A1组与A2组的右心功能指标TAPSE、S^＋、FAC及FWLS差异有统计学意义（P〈0．01），RVIMP差异无统计学意义（P=0．188）。右室FWLS识别右心衰竭的曲线下面积最大（0．864，P〈0．001）。右心房面积（OR：1．212，95％CI=1．004—1．48，P=0．046）和右室FWLS（OR：0．662，95％CI=0．470—0．933，P=0．018）是右心衰竭的独立预测因子。结论与传统右心功能指标相比，基于斑点追踪技术的右室FWLS在识别CTEPH患者右心功能不全方面具有优势，有潜在临床应用价值。

Objective To compare the value of right ventricular （RV） free wall longitudinal strain （FWLS） by speckle tracking echocardiography （STE） and conventional parameters in evaluation of RV dysfunction in chronic thromboembolic pulmonary hypertension （CTEPH）. Methods Sixty CTEPH patients were enrolled as group A and 45 pulmonary embolism （PE） patients with normal pulmonary pressure were enrolled as group B in this study. CTEPH patients were divided into 2 subgroups using the World Health Organization （WHO） function classification：patients with WHO I - II were designated as group A1 and those with WHO III - IV were designated as group A2. Conventional RV functional parameters including tricuspid annular plane systolic excursion （TAPSE）, tissue Doppler-derived tricuspid annular systolic velocity （SV）, fractional area change （FAC）, RV index of myocardial performance （RVIMP）, and STE-derived RV FWLS were measured and compared. Clinical right heart failure （RHF） was defined as the presence of symptoms of heart failure and signs of systemic circulation congestion during hospitalization. Results Compared to group B, group A patients had significant enlarged right heart dimension and impaired RV systolic function parameters （all P 〈0. 001 ）. The TAPSE, Sr, FAC, and RV FWLS showed significant differences between CTEPH patients with mild （group A1） and severe symptoms （group A2） （all P〈0.01）, while RVIMP showed no significant difference （P = 0.188）. On receiver operating characteristic analysis, FWLS had the largest AUC to identify RHF （AUC = 0. 864, P 〈0. 001）, when the cutoff value was 15.05%, the sensitivity was 85.71%, and the specificity was 64.29%,respectively. On binary logistic regression analysis, only right atria area （OR = 1. 212, 95 % CI = 1. 004- 1.48, P =0.046） and RV FWLS （OR=0.662,95%CI=0.470- 0.933, P =0.018） were identified as independent predictor of RHF. Conclusions Compared with conventional parameters, RV FWLS showed advantages in identifying abnormal RV function in CTEPH patients.