实时三维超声心动图区分左心衰合并肺高压不同亚型的研究

Real-time three dimensional echocardiography differentiating the subtypes of pulmonary hypertension in left heart failure

目的:探讨应用单心动周期实时三维超声(sRT-3DE)结合传统二维及多普勒超声心动图区分射血分数(EF)减低的左心衰(LVF)患者合并肺高压不同亚型的可行性。方法:经超声心动图检查左室射血分数(LVEF)<50%的60例患者为病例组,通过肺动脉收缩压(sPAP)及肺血管阻力(PVR)分为3个亚组:左心衰不伴肺高压(LVF-NPH)组15例,左心衰伴被动性肺高压(LVF-PPH)组15例,左心衰伴反应性肺高压(LVF-RHP)组30例,正常健康人35例为对照组。病例组及对照组行常规二维超声及sRT-3DE检查,分析获得三维、二维及多普勒超声参数,进行组间对比分析和相关性分析。结果:1LVF-NPH组和对照组比较,左、右室EDVI、ESVI均增大,左右室EF均减低;LVF-PPH组与LVF-NPH组比较,RVESVI增大,LVEF减低;LVFRPH组与LVF-PPH组比较,RVEDVI、RVESVI增大,LVEF、RVEF减小(P<0.05)。2 PVR与sPAP有良好相关性,PVR与RVEF、RVFAC、TAPSE的相关性均优于sPAP,与RVEDV、RVESV的相关性差于sPAP。3ROC曲线分析获得RVEDVI、RVESVI及RVEF诊断RPH的曲线下面积分别为0.732、0.844、0.904;敏感性和特异性良好。结论:sRT-3DE结合传统二维及多普勒超声可以较好地评价LVF患者右室结构和功能状态、区分患者合并肺高压的不同亚型。

Objective: Using single cardiac cycle real-time three dimensional echocardiography(sRT-3DE) combined with conventional two-dimensional(2DE) and Doppler echocardiography to differentiate the subtypes of pulmonary hypertension in left ventricular failure(LVF) with reduced ejective fraction(EF). Methods: In the case group, 60 patients with LVEF<50% measured by sRT-3DE were divided into three subgroups by sPAP and PVR: 15 patients in LVF-NPH group, 15 patients in LVF-PPH group and 30 patients in LVF-RPH group; 35 healthy people were selected as control group. The 2DE and sRT-3DE were performed in all groups to analyze the 2DE, 3DE and Doppler parameters, and the correlation analysis were performed. Results: 1Compared with the control group, the right ventricular EDVI, ESVI increased and LVEF, RVEF decreased in LVFNPH group; Compared with LVF-NPH group, right ventricular ESVI increased and LVEF decreased in LVF-PPH group;Compared with the LVF-PPH group, the right ventricular EDVI, ESVI increased and LVEF, RVEF decreased in LVF-RPH group(P<0.05). 2There was significant correlation between PVR and sPAP. The correlations of PVR with RVEF, RVFAC and TAPSE were better than those of sPAP, but the correlations of PVR with RVEDV and RVESV were worse than those of sPAP. 3The AUCs of ROC curve of RVEDVI, RVESVI and RVEF to differentiate RPH were 0.732, 0.844 and 0.904, respectively, which indicated excellent sensitivity and specificity. Conclusion: sRT-3DE combined with the traditional 2DE and Doppler echocardiography can accurately assess the state of the right ventricular structure and function and differentiate the subtypes of PH in patients with LVF.