HFrEF患者超声右心功能评价指标与NT-proBNP的相关性研究

Correlation between Right Ventricular Echocardiographic Parameters and NT-proBNP in HFrEF Patients

目的研究射血分数减低的心衰(HFrEF)患者超声心动图左右心室功能的相关指标尤其是右室长轴应变指标与血浆氨基末端B型利钠肽前体(NT-proBNP)水平的相关性。方法选取2016年11月至2017年10月期间收治的HFrEF患者51例,采集患者血浆样本并检测NT-pmBNP水平,收集完整二维超声心动图资料。分别测量左室舒张末容积(LVEDV),射血分数(LVEF),左房容积指数(LAVI),舒张早期二尖瓣口血流速度与二尖瓣环运动速度比值(E/e'),三尖瓣环收缩期位移(TAPSE),右室面积变化率(FAC),右房面积(RAA),组织多普勒三尖瓣环收缩期峰值(S'),右室等容收缩期加速度(IVA);应用斑点追踪技术分析右室整体长轴应变(RVGS),右室游离壁长轴应变(RVFWGS),将肺动脉收缩压分为四级。通过相关性分析及偏相关分析,探讨左室及右室心肌功能各项指标与NT-proBNP之间的相关性,以探讨NT-proBNP与心衰代偿机制之间的关系。结果患者血浆NT-proBNP与LVEDV、LVEF、LAVI之间均无显著的相关性(P>0.05);血浆NT-proBNP与E/e'呈较弱的正相关(r=0.280,P<0.05),与肺动脉收缩压(SPAP)、RAA,RVGS、RVFWGS均呈现正相关性(r=0.375、0.378、0.471、0.471,P<0.01);NT-proBNP与TAPSE、FAC,S'呈现为负相关(r=-0.461,-0.393、-0.392,P<0.01),与IVA呈负相关(r=-0.284,P<0.05)。在校正了肺动脉压力分级的影响后,偏相关分析结果显示:NT-proBNP与TAPSE、S'呈负相关(r=-0.319,P<0.05;r=-0.373;P<0.01);与RVGS、RVFWGS呈线性正相关(r=0.456、0.396,P均<0.01)。结论超声心动图评价左室功能的常规指标如LVEF,LVEDV与心衰生物标记物NT-proBNP之间无显著相关性,而结合组织多普勒及二维斑点追踪技术可发现多个右心功能指标、肺动脉收缩压分级和反应左室充盈压的指标均与NT-proBNP有相关性,其中应变指标右室整体长轴应变、右室游离壁长轴应变指标与NT-proBNP的相关性最佳。

Objective To study the correlation between echocardiographic parameters especially the right ventricle longitudinal strain and plasma aminoterminal B-type natriuretic peptide (NT-proBNP) levels in patients with heart failure with reduced ejection fraction (HFrEF). Methods A total of 51 patients with HFrEF admitted to National cardiovascular centre heart failure care union from November 2016 to October 2017 were enrolled. Plasma NT-proBNP and complete two-dimensional echocardiography images were collected. Left ventricular end-diastolic volume (LVEDV), ejection fraction (LVEF), left atrial volume index (LAVI), early diastolic mitral flow velocity and mitral annulus velocity ratio (E/e'), tricuspid annulus systolic displacement (TAPSE), right ventricular area change rate (FAC), right atrial area (RAA), tissue Doppler tricuspid annulus systolic peak (S'), right ventricular isovolumic systolic acceleration (IVA) were measured in each patient. Using speckle tracking technique fix)m the ECHOPAC workstation we analyzed the right ventricular global long-axis strain (RVGS), right ventricular free wall long-axis strain (RVFWGS), and graded pulmonary systolic blood pressure (SPAP) to 4 different levels. Spearman correlation analysis was used to investigate the relationship between left ventricular and right ventricular function parameters and NT-proBNP to explore the relationship between NT-proBNP and heart failure compensation mechanism. Results There was no significant correlation between plasma NT-proBNP and LVEDV LVEF, and LAVI (D.05). Plasma NT-proBNP level was weakly positively correlated with (E/e)(r=0.280, P<0.05), was positively correlated with PH, RAA, RVGS and RVFWGS (r=0.375, 0.378,0.471, 0.471;P<0.01). NT-proBNP were negatively correlated to TAPSE, FAC, S' and IVA (r=-0.461,-0.393,-0.392;P<0.01 or 0.05). After adjustment ofSPAE the results of partial correlation analysis showed that NTproBNP was negatively correlated with TAPSE and S'(r=-0.319, P<0.05;r=-0.373, P<0.01);and RVGS RVFWGS showed a linear positive correlation (r=0.456,0.396;P<0.01). Conclusion Conventional echocardiographic indicators of left ventricular function such as LVEF, LVEDV have no significant linear correlation with heart failure biomarker NT-proBNP combined with tissue Doppler and two-dimensional speckle tracking technology can find multiple right ventricle functional indicators, pulmonary systolic pressure grading, and left ventricular filling pressure were all correlated with NTproBNP Among those echocardiographic parameters, the correlation between right ventricular global long axis strain, right ventricular free wall long axis strain and NT-proBNP was the most significant.