二维斑点追踪技术评价肺动脉压正常的慢性阻塞性肺疾病患者右心室功能研究

Evaluation of right ventricular function in patients with chronic obstructive pulmonary disease with normal pulmonary artery pressure by two-dimensional dot tracking technique

目的研究二维斑点追踪技术(2D-STI)在肺动脉压处于正常状态下的慢性阻塞性肺疾病(COPD)患者右心室功能评价中的价值。方法采用回顾性分析方法,观察对象为2019年6月至2022年6月入院的53例肺动脉压处于正常状态下的COPD患者,将其设为研究组,同时将同一时期入院进行体检的43名健康者设为对照组。收集并比较两组受试者的一般资料(体表面积、基础心率、年龄、性别),记录心血管疾病史。两组受试者均于平静呼吸状态下选取GE vivid E9超声诊断仪采集3个心动周期心尖四腔二维动态影像,记录并比较两组受试者的常规超声参数[右心室面积变化分数(RVFAC)、右心室收缩期内径(RVDs)、肺动脉收缩压(PASP)、右心室舒张期内径(RVDd)、右心室射血分数(RVEF)、右心室壁厚度(RVWH)、左心室射血分数(LVEF)、E峰、A峰、E/A、E峰减速时间(DT)、右心室Tei指数、右房室瓣环运动速度(e’)、右房室瓣尖血流速度(E)/e’],于Echo PAC工作站中导入动态影像并予以脱机分析,脱机分析选取2D-STI软件,对两组受试者的右心室游离壁中间位置、心尖位置、基底位置及整体长轴应变功能进行对比。结果两组受试者RVFAC、RVEF、RVDs、RVDd、PASP、LVEF、E峰、E/A、DT、右心室Tei指数、e’、E/e’比较,差异均无统计学意义(P>0.05);研究组患者RVWH明显高于对照组,A峰明显低于对照组,差异均有统计学意义(P<0.05)。研究组患者右心室游离壁心尖段、中间段、基底段、整体长轴应变功能明显均低于对照组,差异均有统计学意义(P<0.05)。结论2D-STI用于肺动脉压处于正常状态下的COPD患者右心室功能评价中具有显著效果,可于早期阶段明确右心室功能出现的轻微变化,为临床治疗提供指导。

Objective To study the value of two-dimensional speckle tracking(2D-STI)in evaluating right ventricular function in patients with chronic obstructive pulmonary disease(COPD)with normal pulmonary artery pressure.Methods Using a retrospective analysis method,53 COPD patients with normal pulmonary artery pressure admitted from June 2019 to June 2022 were included in the study group.And 43 healthy persons admitted to the hospital for physical examination at the same time were assigned to the control group.The general data(body surface area,basic heart rate,age,sex)of the two groups were collected and compared,and the history of cardiovascular disease were recorded.Two groups of subjects selected GE vivid E9 ultrasonic diagnostic instrument to collect two-dimensional dynamic images of apical four chambers in three cardiac cycles under calm breathing state,the routine ultrasound parameters[right ventricular area change fraction(RVFAC),right ventricular ejection fraction(RVEF),right ventricular systolic diameter(RVDs),right ventricular diastolic diameter(RVDd),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF),right ventricular wall thickness(RVWH),E peak,A peak,E/A ratio,E peak deceleration time(DT),right ventricular Tei index,right atrioventricular annulus velocity(e'),right atrioventricular apical blood flow velocity(E)/e'ratio]were recorded,and the dynamic images were imported into the Echo PAC workstation,the 2D STI analysis software was selected for offline analysis,and the apical,intermediate,basal,and global long-axis strains of the free wall of the right ventricle were recorded.Results There were no statistically significant differences in RVFAC,RVEF,RVDs,RVDd,PASP,LVEF,E peak,E/A ratio,DT,right ventricular Tei index,e',E/e'ratio between the two groups(P>0.05);the RVWH of the study group was significantly higher than that of the control group,and the A-peak was significantly lower than that of the control group,the differences were statistically significant(P<0.05).The strain function of apical segment,middle segment,basal segment and whole long axis of the free wall of the right ventricle in the study group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion 2D-STI has a significant effect on the evaluation of right ventricular function in COPD patients with normal pulmonary artery pressure.It can identify the slight changes of right ventricular function at the early stage and provide guidance for clinical treatment.