右心室纵向应变评价肺动脉高压患者右心室功能的研究

Study on right ventricular longitudinal strain for evaluating right ventricular function in pulmonary hypertension

目的:应用二维斑点追踪成像技术(2D-STI)测量肺动脉高压(PH)患者右心室纵向应变(RVLS),评价PH患者右心功能,并探讨不同病因肺动脉高压对右心功能的影响。方法:选取92例肺动脉高压而左心功能正常患者,其中先天性心脏病房间隔缺损肺动脉高压(ASDPH)患者37例,动脉性肺动脉高压(PAH)患者26例,慢性血栓栓塞性肺动脉高压(CTEPH)患者29例;健康体检者30例为对照组。测量常规超声心动图参数:右心室横径(RVTD),左心室横径(LVTD),RVTD/LVTD比值,主肺动脉内径(DMPA),左肺动脉内径(DLPA),右肺动脉内径(DRPA),三尖瓣反流面积(ATR);功能参数:右心室面积变化分数(FAC)、三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期峰值速度(S丿)、右心做功指数(RIMP)、LVEF。根据三尖瓣反流压差测量肺动脉收缩压(PASP)。应用2D-STI测量RVLS。结果:肺动脉高压各组RVTD、DMPA、DLPA、DRPA、RVTD/LVTD比值,RVSL、RIMP、TAPSE、FAC、S丿与对照组比较(P<0.05);肺动脉高压各组性别、年龄、LVEF与对照组比较,P>0.05,差异无统计学意义;ASDPH组RVTD,DMPA,DLPA,DRPA,明显高于APH组和CTEPH组(P<0.05);ASDPH组LVTD明显高于APH组、CTEPH组和对照组(P<0.05);ASDPH组和CTEPH组ATR明显高于对照组(P<0.05);ASDPH组RVTD/LVTD比值高于PAH组(P<0.05);ASDPH组TAPSE大于PAH组和CTEPH组(P<0.05);ASDPH组RVSL小于PAH组和CTEPH组(P<0.05)。(2)相关性分析:RVLS与TAPSE、FAC呈负相关(r=-0.532,P=0.016;r=-0.507,P=0.001);RVLS与RIMP呈正相关(r=0.510,P=0.003);PAH组RVLS与PASP无明显相关性(r=0.285,P=0.130);ASDPH组和CTEPH组RVLS与肺动脉收缩压(PASP)呈正相关(r=0.602,P=0.007;r=0.567,P=0.008)。结论:RVSL能反映不同病因肺动脉高压患者右心功能,对不同类型肺动脉高压的诊断和鉴别诊断有参考价值。

Objective: To measure right ventricular longitudinal strain(RVLS) in patients with pulmonary hypertension(PH) by 2D speckle tracking imaging(2D-STI),and evaluate right ventricular function,and investigate impaction of right ventricular function with different pulmonary hypertension. Methods: 92 patients with pulmonary hypertension were divided into 3 groups, 37 patients with atrial septal defect pulmonary hypertension(ASDPH),26 patients with pulmonary arterial hypertension(PAH),29 patients with chronic thromboembolic pulmonary hypertension(CTEPH),and compared with a control group of 30 healthy volunteers. Measure normal cardial ultrasonic parameters. Structure parameters: right ventricular transverse diameter(RVTD),left ventricular transverse diameter(LVTD), ratio of RVTD/LVTD, main pulmonary artery diameter(DMPA), left pulmonary artery diameter(DLPA),right pulmonary artery diameter(DRPA), tricuspid regurgitation area(ATR);Function parameters: right ventricular fractional area change(FAC), tricuspid annular plane systolic excursion(TAPSE), tricuspid lateral annular systolic velocity(S丿), RV index of myocardial performance(RIMP), LVEF. To measure pulmonary artery systolic pressure(PASP) by tricuspid regurgitation pressure difference.To measure RVLS by 2D-STI. Results: 1 RVTD, DMPA, DLPA, DRPA, the ratios of RVTD/LVTD, RVSL, RIMP, TAPS, FAC, S丿have significant difference between three PH groups and controls(all P<0.05). There were no difference of the sex age and LVEF between PH and controls( P>0.05). RVTD, DMPA, DLPA, DRPA were significantly higher in ASDPH than in APH and CTEPH(all P<0.05). LVTD was significantly higher in ASDPH than in APH, CTEPH and controls. ATR was significantly higher in ASDPH and CTEPH than in controls(P<0.05);The ratio of RVTD/LVTD was significantly higher in ASDPH than in PAH(P<0.05);TAPSE was significantly higher in ASDPH than in CTEPH and PAH(P<0.05);RVSL was significantly lower in ASDPH than in CTEPH and PAH(P<0.05). 2 Correlation analysis: RVLS has a negative correlation with TAPSE and FAC(r=-0.532, P=0.016;r=-0.507,P=0.001), RVLS has a positive correlation with RIMP(r=0.510, P=0.003), RVLS has no correlation with PASP in PAH group(r=0.285, P=0.130);RVLS has a positive correlation with RVLS in ASDPH and CTEPH groups(r=0.602, P=0.007;r=0.567, P=0.008). Conclusions: RVLS can response right heart function of different PH. It has reference value for different types PH of diagnosis and differential diagnosis.