二维斑点追踪超声心动图对业余马拉松运动员右心室收缩功能的评估

Assessment of right ventricular systolic function in amateur marathoners by two-dimensional specking echocardiography

目的应用二维斑点追踪超声心动图评估业余马拉松运动员右心室收缩功能。方法2019年1月至2020年12月,在杭州地区招募业余马拉松运动员88例,根据参加马拉松运动时限分为短期组(≤6个月)、中长期组(6个月~3年)和长期组(>3年);另选取同一时期在杭州师范大学附属医院体检的健康受试者30例为对照组。应用常规超声心动图测量右心室流出道内径(RVOT)、右心室基底段内径(RVD_(basal))及中间段内径(RVD_(mid))、右心室剑突下切面室壁厚度(RVWT)、三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期速度(S′)、右心室心肌做功指数(RIMP)和肺动脉收缩压(SPAP),应用二维斑点追踪技术获得右心室整体纵向应变(GLS)和游离壁纵向应变(RVLS)。对业余马拉松运动员在完成全程马拉松运动前、运动后1 h和运动后第4天分别行超声心动图检查。对4组受试者的常规超声心动图参数及右心室应变参数进行比较,并分析马拉松运动员运动前GLS、RVLS与SPAP的相关性。结果短期组TAPSE高于对照组,差异有统计学意义(P<0.05);中长期组RVOT、RVD_(basal)、RVD_(mid)、RVWT均高于短期组,差异有统计学意义(P均<0.05);长期组RVOT、RVD_(basal)、RVD_(mid)均高于中长期组,差异有统计学意义(P均<0.05);长期组RVWT、RIMP、SPAP高于对照组,差异有统计学意义(P均<0.01)。短期组RVLS高于对照组,差异有统计学意义(P<0.05);长期组GLS低于短期组及对照组,差异有统计学意义(P均<0.05)。运动后1 h及第4天中长期组GLS、RVLS低于短期组,差异均有统计学意义(Z=2.416、-2.579,Z=2.254、-3.005,P均<0.05),长期组GLS、RVLS亦低于短期组,且差异均有统计学意义(Z=-2.858、-2.825,Z=-3.524、-4.073,P均<0.05)。组内运动前后比较,中长期组、长期组运动后1 h GLS均低于运动前,差异有统计学意义(Z=-1.968、-1.966,P均<0.05);短期组、中长期组和长期组运动后1 h RVLS均低于运动前,差异有统计学意义(Z=2.011、-2.258、-2.026,P均<0.05)。相关性分析表明,运动员组运动前的GLS、RVLS与SPAP存在相关性(r=0.378、0.325,P均<0.01)。结论业余马拉松运动员早期右心室游离壁纵向收缩功能增强,随着运动年限增加右心室整体纵向收缩功能减低;全程马拉松运动后右心室游离壁收缩功能短暂下降。

Objective To assess the right ventricular(RV)systolic function in amateur marathoners by two-dimensional specking echocardiography.Methods A total of 88 amateur marathon runners were recruited between January 2019 and December 2020 in Hangzhou and were divided into a shortterm(ST)group(≤6 months),a more extended-term(MET)group(6 months-3 years),and a long-term(LT)group(>3 years)based on their time of participating in a marathon.Thirty healthy volunteers from the Affiliated Hospital of Hangzhou Normal University were enrolled during the same period as a control group.Conventional echocardiography was performed to measure RV outflow tract(RVOT),RV basal diameter(RVD_(basal)),RV mid-diameter(RVD_(mid)),RV wall thickness(RVWT),tricuspid annular plane systolic excursion(TAPSE),pulsed tissue Doppler tricuspid annular plane systolic velocity(S'),RV index of myocardial performance(RIMP),and systolic pulmonary artery pressure(SPAP).RV global longitudinal strain(GLS)and RV free wall longitudinal strain(RVLS)were calculated via Qlab10.8 analysis software offline.Echocardiography was performed before marathon,1 hour post-marathon,and 4 days postmarathon on amateur marathon runners.The correlation of GLS and RVLS with SPAP in amateur marathon runners was further analyzed.Results Compared with the control group,the ST group showed a significant increase in TAPSE(P<0.05).Compared with the ST group,the MET group showed a significant increase in RVOT,RVD_(basal),RVD_(mid),and RVWT(P<0.05 for all);the RVOT,RVD_(basal),and RVD_(mid) in the LT group were further increased compared to those of the MET group(P<0.05 for all).Compared with the control group,RVWT,RIMP,and SPAP in the LT group were significantly increased(P<0.01 for all).Compared with the control group,the ST group showed a significant increase in RVLS(P<0.05),while GLS in the LT group was significantly decreased in the ST group and control group(P<0.05 for both).Compared with the ST group,the MET group(Z=2.416,-2.579;Z=2.254,-3.005;P<0.05 for both)and ST group(Z=-2.858,-2.825;Z=-3.524,-4.073;P<0.05 for both)showed a significant decrease in GLS and RVLS at 1 hour and 4 days post-marathon.In intra-group comparisons,GLS at 1 hour post-marathon in both the MET and LT groups,and RVLS at 1 hour post-marathon in the ST,MET,and LT groups were significantly decreased in relative to pre-marathon values(Z=-1.968,-1.966;Z=2.011,-2.258,2.026;P<0.05 for all).Correlation analysis revealed that pre-marathon GLS and RVLS had a correlation with SPAP(r=0.378,0.325;P<0.01 for both).Conclusion The systolic function of RV free wall of amateur marathon runners increases in the early stage.Runners who have participated in the marathon for a long time have reduced GLS of the RV.There is a temporary post-marathon decrease in the systolic function of the RV free wall.