经食管实时三维超声心动图定量评价肺动脉高压患者右心结构及血流动力学的价值

Quantitative evaluation of right heart structure and hemodynamics in patients with pulmonary hypertension by real-time three-dimensional transesophageal echocardiography

目的:探究经食管实时三维超声心动图定量评价肺动脉高压(PH)患者右心结构及血流动力学的临床价值。方法:将2016年5月至2019年2月收治的160例PH患者作为研究组,2016年4月至2017年12月的160名健康体检者作为对照组。常规经胸超声心动图检测右心室为中心取心尖四腔切面测量右心室横径(RVTD)、左心室横径(LVTD)。采集5个心动周期的右心三维动态图像测量右心收缩末期容积(RESV)、局部每搏量(RSV)、舒张末期容积(REDV)、射血分数(REF)。检测受试者的肺部和右心血流动力学参数:肺动脉舒张压(DPAP)、肺动脉平均压(MPAP)、右心输出量(RCO)。结果:PH患者的RESV、RSV、REDV、RVTD及LVTD分别为(62.33±26.12)mL、(67.43±20.37)mL、(105.23±30.19)mL、(47.12±8.11)mm、(32.49±5.13)mm,均高于对照组(P<0.05)。PH患者的REF为(32.19±8.71)%,低于对照组(P<0.05)。PH患者的SPAP、DPAP、MPAP、RCO分别为(68.49±19.12)、(60.22±21.13)、(48.90±11.32)、(4.10±1.07)mmHg,其中SPAP、DPAP和MPAP高于对照组,ROC结果低于对照组(P<0.05)。结论:PH患者因肺动脉高血压引起的右心衰竭较明显,需要早期对PH患者进行右心功能监测。RT-3D-TEE在监测PH患者准确度较高,能更好的指导医生治疗,值得临床推广应用。

Objective:To investigate the clinical value of real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)in quantitative evaluation of right heart structure and hemodynamics in patients with pulmonary hypertension(PH).Methods:A total of 160 PH patients admitted to our hospital between May 2016 and February 2019 were enrolled as the study group.A cohort of 160 health checkup individuals in our hospital between April 2016 and December 2017 were enrolled as the control group.Routine:transthoracic echocardiography was performed to measure the right ventricular transverse diameter(RVTD)and left ventricular transverse diameter(LVTD).With RT-3D-TEE,dynamic images of the right heart over five cardiac cycles were acquired to measure the right ventricular end-systolic volume(RESV),right ventricular regional stroke volume(RSV),right ventricular end-diastolic volume(REDV),and right ventricular ejection fraction(REF).The lung and right heart hemodynamic parameters measured for all subjects were diastolic pulmonary artery pressure(DPAP),mean pulmonary artery pressure(MPAP),and right cardiac output(RCO).Results The RESV,RSV,REDV,RVTD and LVTD in the PH patients were 62.33±26.12 ml,67.43±20.37 ml,105.23±30.19 ml,47.12±8.11 mm,and 32.49±5.13 mm,which were significantly greater than those in the control group(P<0.05).The REF in patients with PH was 32.19±8.71%,which was lower than that in the control group(P<0.05).The SPAP,DPAP,MPAP,and RCO in PH patients were 68.49±19.12 mmHg,60.22±21.13 mmHg,48.90±11.32 mmHg,and 4.1±1.07 mmHg,respectively;among these,the SPAP,DPAP and MPAP were higher,and the ROC was lower,in PH patients compared with controls(P<0.05).Conclusion:Patients with PH have obviously right heart failure due to pulmonary hypertension that necesssitates early monitoring of the right heart function.RT-3D-TEE is satisfatorily accurate in such monitoring and well-competent in guiding the treatment,which warrants widespread use in clinical setting.