应用自动功能成像技术探讨心房颤动患者右心室重构的临床应用价值

Automatic functional imaging to evaluate right ventricular remodeling in patients with atrial fibrillation

目的 应用自动功能成像技术的三维自动右心室定量和自动应变定量技术研究心房颤动(房颤)对右心解剖结构和功能的影响,为临床评估房颤患者右心结构和功能的改变提供一种全新、快捷的手段。方法 选取兰州大学第一医院2020年8月至2021年7月间收治的35例房颤患者,设为房颤组,随机抽取体检正常者30人作为对照组。应用常规超声心动测量两组患者下列二维参数:右心室基底段横径(RVD1)、右心室中段横径(RVD2)、右心室上下径(RVD3)、右心室面积变化分数(RVFAC)、三尖瓣环位位移(TAPSE)。应用自动功能成像(AFI)技术对动态影像进行分析,测量两组患者的室间隔应变、右心室游离壁应变、整体纵向应变、右心室游离壁各节段(基底段、中间段、心尖段)收缩时的纵向峰值应变,比较两组患者各测值的差异。结果 两组受检者常规超声各种测值的比较,RVD1[(34.34±3.86)mm比(38.13±5.23)mm],RVD3[(74.14±11.45)mm比(79.47±7.33)mm],RVFAC[(41.61±11.66)mm比(34.77±10.49)mm],TAPSE[(19.12±5.01)mm比(15.49±5.90)mm]的差异具有统计学意义(P<0.05),RVD2房颤组较对照组增大,差异无统计学意义(P>0.05)。两组受检者ST参数比较,游离壁基底段应变[(-30.50±7.06)%比(-16.43±14.94)%]、游离壁中段应变[(-21.00±8.12)%比(-13.85±10.34)%]、游离壁心尖段应变[(-19.62±5.52)%比(-9.98±6.97)%]、整体纵向应变[(-18.41±8.00)%比(-11.56±7.15)%],房颤组右心室游离壁基底段、中段、心尖段和右心室整体纵向应变值降低,差异具有统计学意义(P<0.05);游离壁应变、间隔应变虽较对照组降低,但差异无统计学意义(P>0.05);三维右心室收缩功能比较,EDVI[(48.55±7.54)比(52.64±13.36)]、ESVI[(24.00±4.50)比(30.84±8.75)]、SV[(41.60±9.47)比(39.25±13.73)]、EF[(50.11±5.95)%比(41.19±8.21)%],房颤组右心室的每搏量、射血分数与对照组比较均有减低,收缩、舒张容积指数增加,且差异均有统计学意义(P<0.05)。结论应用自动功能成像技术(AFI)对于早期检测AF患者右心室应变下降、结构重塑和收缩功能下降有提示作用。

Objective To explore the effects of atrial fibrillation(AF)on the anatomical structure and function of the right heart applying three-dimensional automatic right ventricular quantification and automatic strain quantification with automatic functional imaging technology to provide a new and rapid means to clinically assess the changes in the structure and function of the right heart in patients with AF.Methods 35 patients with atrial fibrillation admitted to the First Hospital of Lanzhou University from August 2020 and July 2021 were selected as the case group,and 30 people with normal physical examination were randomly selected as the control group.The following two-dimensional parameters were measured by conventional echocardiography in both groups:right ventricular basal segmental transverse diameter(RVD1),right ventricular mid-segmental transverse diameter(RVD2),right ventricular length diameter(RVD3),right ventricular fractional area change(RVFAC)and tricuspid valve annular displacement(TAPSE).The automatic functional imaging(AFI)technique was applied to analyze the dynamic images;and the septal strain,right ventricular free wall strain,overall longitudinal strain,and peak longitudinal strain during contraction of each segment of the right ventricular free wall(basal,intermediate,and apical segments)were measured in the two groups;and the differences between the two groups were compared for each measurement.Results Comparison of various measurements of conventional ultrasound in the two groups of subjects were follows:RVD1[(34.34±3.86)mm vs.(38.13±5.23)mm],RVD3[(74.14±11.45)mm vs.(79.47±7.33)mm],RVFAC[(41.61±11.66)mm vs.(34.77±10.49)mm],TAPSE[(19.12±5.01)mm vs.(15.49±5.90)mm]were statistically significant(P<0.05);RVD2 were increased in the atrial fibrillation group compared to the control group,but the differences were not statistically significant(P>0.05).When comparing ST parameters between the two groups,that showed the free wall basal segment strain[(-30.50±7.06)%vs.(-16.43±14.94)%],the free wall mid-segment strain[(-21.00±8.12)%vs.(-13.85±10.34)%],the free wall apical segment strain[(-19.62±5.52)%vs.(-9.98±6.97)%]and the overall longitudinal strain[(-18.41±8.00)%vs.(-11.56±7.15)%];the right ventricular free wall basal,the mid,the apical and overall right ventricular longitudinal strain values decreased in the atrial fibrillation group,and the differences were statistically significant(P<0.05);although the free wall strain and septal strain were lower than the control group,the differences were not statistically significant(P>0.05).3D right ventricular systolic function was compared with EDVI[(48.55±7.54)vs.(52.64±13.36)],ESVI[(24.00±4.50)vs.(30.84±8.75)],SV[(41.60±9.47)vs.(39.25±13.73)]and EF[(50.11±5.95)%vs.(41.19±8.21)%];the right ventricular volume per beat and ejection fraction were reduced and systolic and diastolic volume indices were increased in the atrial fibrillation group compared with the control group,and all differences were statistically significant(P<0.05).Conclusion The application of automatic functional imaging(AFI)technology has a suggestive effect on early detection of right ventricular strain reduction,structural remodeling and decreased systolic function in AF patients.