高血压病右心室收缩功能的四维容积定量分析

Four-dimensional Quantitative Analysis of Right Ventricular Systolic Function in Hypertension

目的应用四维右心室容积定量分析(4D-RV-Volume)探讨高血压病伴或不伴左心室肥厚不同阶段右心室收缩功能改变。资料与方法对96例临床确诊的高血压患者按左心室质量指数(LVMI)分为LVMI正常组(49例)和LVMI增高组(47例),并选取健康对照组53例,行超声心动图检查运用4D-RV-Volume获取右心室射血分数(RVEF)、舒张末期容积(RVEDV)、收缩末期容积(RVESV)、游离壁纵向应变率(RVFLS)、室间隔纵向应变率(RVSLS)、面积变化分数(RVFAC)、三尖瓣环收缩期位移(TAPSE)等右心室功能参数,比较各组间的差异。结果与对照组比较,高血压各组的RVEF、RVFLS及RVFAC均减低,差异有统计学意义(P<0.05);与LVMI正常组比较,LVMI增高组RVEF、RVFLS、TAPSE及RVFAC进一步减低,差异有统计学意义(P<0.05);RVEF与RVFAC呈正相关(r=0.721,P<0.01);当RVEF为46.5%(AUC=0.859,P<0.001)时,诊断价值最高,其敏感度为68.0%,特异度为85.7%。结论高血压不同时期存在右心室收缩功能异常,4D-RV-Volume为临床早期评价高血压患者右心室功能不全提供了新方法。

Purpose To explore the change of right ventricular systolic function in hypertensive patients with or without left ventricular hypertrophy at different stages using four-dimensional right ventricular quantitative analysis（4D-RV-Volume）. Materials and Methods Ninety-six cases of clinically diagnosed hypertension were divided into left ventricular mass index（LVMI） normal group（49 cases） and LVMI increased group（47 cases） according to LVMI, and 53 cases were chosen from healthy control group for echocardiography to check parameters of right ventricular systolic function such as right ventricular ejection fraction（RVEF）, end-diastolic volume（RVEDV）, endsystolic volume（RVESV）, longitudinal strain rate of free wall（RVFLS）, longitudinal strain rate of ventricular septum（RVSLS）, fractional area change（RVFAC）, tricuspid annular plane systolic excursion（TAPSE）, and the difference among groups were compared. Results Compared with control group, RVEF, RVFLS, and RFAFC in all hypertension groups decreased, the difference of which was statistically significant（P〈0.05）; compared with LVMI normal group, RVEF, RVFLS, TAPSE and RFAFC in LVMI increased group further decreased, the difference of which was statistically significance（P〈0.05）; RVEF was positively correlated with RFAFC（r=0.721, P〈0.01）; when RVEF was 46.5%（AUC=0.859, P〈0.001）, the diagnostic value was the highest with a sensitivity of 68.0%, and specificity of 85.7%. Conclusion Right ventricular systolic dysfunction exists in different periods of hypertension, and 4D-RV-Volume provides a new approach for early evaluation of right ventricular dysfunction in hypertensive patients.