二维斑点追踪成像技术评价慢性阻塞性肺病伴不同程度肺动脉高压患者的右心室功能变化

Clinical significance of two-dimensional speckle tracking imaging for evaluating right ventricular function in COPD patients with pulmonary hypertension

目的探讨二维斑点追踪成像技术(2D-STI)评价慢性阻塞性肺病(COPD)伴不同程度肺动脉高压(PH)患者右心室功能变化的临床价值,为COPD伴不同程度PH患者右心室功能估测与治疗提供依据。方法选取2021年5月至2022年5月在南京医科大学附属南京脑科医院(胸科院区)确诊的52例COPD伴不同程度PH患者作为观察组,根据肺动脉收缩压(sPAP)将患者分为COPD伴轻度PH组20例(36 mm Hg≤s PAP<50 mmHg,A组),COPD伴中度PH组16例(50 mm Hg≤s PAP<70 mmHg,B组)和COPD伴重度PH组16例(sPAP≥70 mmHg,C组),选择同时段27例COPD不伴PH患者作为对照组。常规超声心动图获取右室基底部横径(RV)、主肺动脉内径(DPA)、三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期峰值流速(S’)、右室面积变化率(FAC)、右心做功指数(MPI);2D-STI获取右室游离壁基底段纵向应变(Sb)、右室游离壁中间段纵向应变(Sm)、右室游离壁心尖段纵向应变(Sa)、右室游离壁纵向收缩期峰值应变(RVLPSS),比较各组参数的差异;采用Pearson相关性分析研究RVLPSS与TAPSE、FAC、S’、MPI间的相关性;采用受试者工作特征(ROC)曲线研究RVLPSS判断右心室功能指标下降的敏感性与特异性。结果与对照组比较,A组患者的MPI增大,差异有统计学意义(P<0.05),而RV、DPA增大差异无统计学意义(P>0.05);此外B组、C组中RV、DPA、MPI均增大,且随着病情的恶化呈逐渐增大趋势(P<0.05);与对照组比较,A组、B组、C组中FAC、TAPSE、S’、Sb、Sm、Sa、RVLPSS均减小,且随着病情进展呈依次减小趋势(P<0.05)。经Pearson相关性分析结果显示,RVLPSS与TAPSE(r=-0.819,P=0.000)、FAC(r=-0.856,P=0.000)、S’(r=-0.799,P=0.000)呈负相关性,与MPI呈正相关性(r=0.844,P=0.000);经ROC分析结果显示,RVLPSS为-19.5%时判断TAPSE<17 mm的敏感性为95%、特异性为87.5%,判断FAC<35%的敏感性为86.96%、特异性为89.66%,判断S’<9.5 cm/s的敏感性为94.4%、特异性为82.4%,判断MPI>0.54的敏感性为73.33%、特异性为95.45%。结论2D-STI与评价右心室功能的指标相关性良好,能有效、准确评估COPD伴不同程度PH患者右心室功能变化,为患者的病情分级、治疗评价及预后判断提供依据。

Objective To investigate the clinical significance of two-dimensional speckle tracking imaging(2D-STI)for evaluating right ventricular function in COPD patients with pulmonary hypertension(PH)and provide evidence for the assessment and treatment in COPD patients with PH.Methods A total of 52 COPD patients with PH(PH group)and 27 COPD patients without PH(normal control group)in the Affiliated Brain Hospital of Nanjing Medical University(Chest Branch)from May,2021 to May,2022 were prospectively recruited.According to systolic pulmonary artery pressure(sPAP),the patients in PH group were divided into 3 subgroups:mild PH subgroup(36≤sPAP<50 mmHg,n=20,group A),moderate PH subgroup(50≤sPAP<70 mmHg,n=16,group B),and severe PH subgroup(sPAP≥70 mmHg,n=16,group C).Right ventricular base diameter(RV),main pulmonary artery diameter(DPA),tricuspid annular plane systolic excursion(TAPSE),tricuspid annular peak systolic velocity(S’),fractional area change(FAC),and myocardial performance index(MPI)were measured by conventional echocardiography.Longitudinal strain of the basal segment of the right ventricular free wall(Sb),longitudinal strain of the middle segment of the right ventricular free wall(Sm),longitudinal strain of the apical segment of the right ventricular free wall(Sa),and RV free wall longitudinal peak systolic strain(RVLPSS)were measured by 2D-STI.Pearson correlation analysis(PCA)was introduced to analyze the correlations between RVLPSS and TAPSE,FAC,S’,as well as MPI.The receiver operating characteristic(ROC)analysis was used to evaluate the diagnostic efficacy of RVLPSS in predicting the variation of right ventricular function in patients with PH.Results Compared with the control group,MPI was increased significantly in group A(P<0.05),while RV or DPA showed no statistically significant differences between control group and group A(P>0.05).As compared with group A,RV,DPA,and MPI in group B and group C increased significantly(P<0.05),and they increased as the disease condition worsens.Compared with the control group,FAC,TAPSE,S',Sb,Sm,Sa,RVLPSS in groups A,B,and C all decreased,and showed a decreasing trend as the disease condition progressed(P<0.05).Pearson correlation analysis revealed that RVLPSS was negatively correlated with TAPSE(r=-0.819,P=0.000),FAC(r=-0.856,P=0.000),and S’(r=-0.799,P=0.000),while positively correlated with MPI(r=0.844,P=0.000).ROC analysis suggested that when RVLPSS was-19.5%,the sensitivity and specificity were 95%and 87.5%for determining TAPSE<17 mm,86.96% and 89.66% for determining FAC<35%,94.4% and 82.4% for determining S'<9.5 cm/s,73.33% and 95.45% for determining MPI>0.54.Conclusion 2D-STI has a good correlation with the indexes for evaluating right ventricle function.It can effectively and accurately evaluate the changes of right ventricle function in COPD patients with different levels of PH,and provide reliable evidences to for the classification,treatment evaluation,and prognosis judgment of the patients.