实时三维超声心动图评价结缔组织病相关肺动脉高压患者的右室逆向重构

Reverse right ventricular remodeling in patients with connective tissue disease associated pulmonary arterial hypertension evaluated by RT-3DE

目的:使用实时三维超声心动图(RT-3DE)评估结缔组织病相关肺动脉高压(CTD-PAH)患者短期治疗后右室的逆向重构。方法:选取2015年7月-2018年12月我院风湿免疫科住院的连续CTD患者,根据2015 ESC/ERS指南肺动脉高压可能性等级高级者人选。常规超声和RT-3DE获得超声参数包括肺动脉收缩压(PASP)、右室收缩、舒张末容积指数及射血分数(RVEDVi.RVESVi及RVEF)。搜集患者临床资料包括CTD疾病种类、药物治疗、WHO心功能等级、血浆脑钠肽(BNP)等。首次检查后3~6月随访上述超声及临床资料。根据随访临床情况定义临床好转,分析临床好转患者的右室逆向重构。结果:57例患者经过平均随访时间(4.2±0.9)月,56.1%患者获得临床好转,好转组基线状态下BNP水平、PASP低于无好转组(P<0.01)。好转组随访时WHO-FC、BNP、PASP显著减低,右心室容积明显缩小,功能明显增高(P<0.001),PASP变化与BNP变化无显著相关性,右心室容积和RVEF的变化与BNP变化显著相关,其中RVESVi与BNP相关性最好(r=0.651,P<0.001)。结论:CTD-PAH患者右心室的逆向重构与BNP减低显著相关,RT-3DE获得的RVESVi可作为评价逆向重构的良好指标。

Objective:Real-time three-dimensional echocardiography(RT-3DE)was used to assess reverse remodeling of the right ventricle(RV)following short-term therapy in patients with connective tissue disease associated pulmonary arterial hy-pertension(CTD-PAH).Methods:Consecutive CTD patients admitted to the Department of Rheumatology and Immunology of our hospital from July 2015 to December 2018 were selected.According to the 2015 ESC/ERS guidelines for pulmonary hy-pertension(PH),those patients with"high"PH possibility were enrolled.Echocardiographic parameters derived from convention-al echocardiography and RT-3DE including pulmonary arterial systolic pressure(PASP),right ventricular end-diastolic volume index(RVEDVi),end-systolic volume index(RVESVi)and ejection fraction(RVEF)were measured.Clinical data were collected including the types of CTD diseases,drug treatment,WHO functional classification,BNP,etc.The patients were followed up for 3 to 6 months after the initial enrolled.Clinical improvement was defined according to the follow-up clinical situation,and the RV reverse remodeling in patients with clinical improvement was analyzed.Results:After an average follow-up time of 4.2±0.9 months,56.1%of the 57 patients achieved clinical improvement,and the BNP and PASP in the improved group were lower than thuse in the non-improved group at baseline(P<0.01).During the follow-up of the improved group,WHO-FC,BNP and PASP were significantly decreased,RV volume was significantly decreased,and RVEF was significantly increased(P<0.001).The change of PASP was not significantly correlated with the change of BNP level,while the change of RV volume and RVEF were significantly correlated with the change of BNP level,among which RVESVi had the best correlation with BNP(r=0.651,P<0.001).Conclusions:RV reverse remodeling in CTD-PAH patients is significantly correlated with BNP reduc-tion and RVESVi derived from RT-3DE can be used as a good indicator to evaluate RV reverse remodeling.