超声心动图评价慢性血栓栓塞性肺动脉高压球囊肺血管成形术疗效的研究

Evaluation of the efficacy of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension by echocardiography

目的应用超声心动图评价慢性血栓栓塞性肺动脉高压(CTEPH)患者球囊肺血管成形(BPA)术前、术后血流动力学及右心功能改善情况,探讨该介入治疗方法的临床应用价值。方法选取2016年9月至2019年1月于首都医科大学附属北京朝阳医院行BPA治疗的中-高危危险分层的CTEPH患者36例。常规参数包括右心室横径(RVD)、左心室横径(LVD)、右心房横径(RAD)、左心房横径(LAD)、肺动脉主干内径(DMPA)、左室偏心指数(LVEI)、左室射血分数(LVEF)及肺动脉收缩压(SPAP)。右心功能参数包括三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(RVFAC)、三尖瓣环收缩期峰值速度(S′)、右心做功指数(RIMP)及右室游离壁长轴纵向应变(GLS)。以术后SPAP50mmHg为界值将患者分为2组,组Ⅰ患者为术后SPAP≤50mmHg,组Ⅱ患者为术后SPAP>50mmHg。比较BPA术前及术后各参数改变情况。结果①36例CTEPH患者行BPA干预次数为1~6次不等。BPA术后患者SPAP下降,TAPSE、RVFAC及GLS绝对值升高,RIMP减低(均P<0.05)。②组Ⅰ患者术前右心功能参数TAPSE、RVFAC及GLS绝对值较组Ⅱ患者高(均P<0.05)。③单因素Logistic回归显示BPA术前右心功能参数TAPSE、RVFAC及GLS对介入手术疗效有影响。结论超声心动图能够评价CTEPH患者BPA术后血流动力学及右心功能改变情况;BPA术后患者肺动脉压力下降,患者右心功能均有不同程度改善,提示BPA手术具有较好的临床应用与推广价值。

Objective To evaluate the cardiac hemodynamics and function before and after balloon pulmonary angioplasty (BPA) treatment in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using echocardiography, and to discuss the clinical value of the treatment. Methods A total of 36 CTEPH patients with medium-high risk stratification underwent BPA during the period of September 2016 to January 2019 in Beijing Chao-Yang Hospital, Capital Medical University were recruited. The following conventional echocardiographic parameters including right ventricular basal diameter (RVD), left ventricular basal diameter (LVD), right atrial diameter (RAD), left atrial diameter (LAD), main pulmonary artery diameter (DMPA), left ventricular eccentricity index (LVEI), left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) were recorded.Echocardiographic parameters of right ventricular (RV) function including tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tissue Doppler–derived tricuspid lateral annular systolic velocity (S′), RV index of myocardial performance (RIMP) and right ventricular free wall longitudinal strain (GLS) were measured. The patients were divided into 2 groups according to the threshold value of postoperative SPAP of 50 mmHg (group Ⅰ: SPAP ≤ 50 mmHg, group Ⅱ: SPAP>50 mmHg). Changes between each parameter before and after BPA were analyzed. Results ①The frequency of BPA treatment for CTEPH patients ranged from 1 to 6 times. After BPA treatment, SPAP decreased significantly, and the measurements of RV function including TAPSE, RVFAC, RIMP and GLS improved significantly (all P<0.05).②Patients in group Ⅰ showed significantly better RV function including TAPSE, RVFAC and GLS compared with group Ⅱ before BPA (P<0.05).③Univariate logistic regression showed that parameters of preoperative RV function TAPSE, RVFAC and GLS had certain effects on the curative effect of interventional surgery. Conclusions Echocardiography can evaluate the hemodynamics and RV function in CTEPH patients with BPA.After BPA, pulmonary artery pressure decreases and RV function improves to some extent, suggesting that the treatment of BPA has certain clinical application and popularization value.