四维超声自动定量技术评价肺动脉高压患者右心房容积和功能异常

Evaluation of abnormalities in right atrial volume and function in patients with pulmonary hypertension by four-dimensional ultrasound automatic quantitation analysis

目的:应用四维超声自动定量技术评价不同程度肺动脉高压(PH)患者右房容积及功能异常,并探讨该技术评估PH患者危险分层及世界卫生组织心功能分级(WHO-FC)的应用价值。方法:连续纳入2022年4-10月于阜外华中心血管病医院经右心导管确诊的成人PH患者84例作为PH组,根据肺动脉平均压(mPAP)分为3组,分别为轻度PH组(28例)、中度PH组(28例)及重度PH组(28例)。同期纳入年龄、性别相匹配的28例健康志愿者作为对照组。应用四维超声自动定量技术对右房四维图像进行分析,获得右房容积和应变参数:右心房最小容积指数(RAVImin)、右心房最大容积指数(RAVImax)、右心房收缩前容积指数(RAVIpreA)、右心房射血分数(RAEF)、右心房被动射血分数(RAPEF)、右心房主动射血分数(RAAEF),右心房储备期、管道期及收缩期纵向应变(RASr、RAScd、RASct),右心房储备期、管道期及收缩期圆周应变(RASr-c、RAScd-c、RASct-c)。比较各组间右心房参数差异。应用ROC曲线分析右房四维应变参数对PH患者WHO-FC≥Ⅲ级的诊断效能。采用Pearson直线相关分析法探讨RASr与右心房面积(RAA)、N端脑利钠肽前体(NT-proBNP)和三尖瓣环收缩期位移/肺动脉收缩压(TAPSE/sPAP)的相关性。结果:①与对照组相比,轻度、中度及重度PH组RAEF、RAPEF、RASr、RAScd、RASr-c、RAScd-c明显降低,而RAAEF、RASct及RASct-c在轻度PH组明显升高,在中度及重度PH组明显降低,差异有统计学意义(均 P<0.05);轻度、中度及重度PH组间RAVImin、RAVImax、RAVIpreA依次增加,差异有统计学意义(均 P<0.05);轻度、中度及重度PH组间RAEF、RAPEF、RAAEF、RASr、RAScd、RASct、RASr-c、RAScd-c、RASct-c依次降低,差异有统计学意义(均 P<0.05)。②ROC曲线表明,RASr对PH患者WHO-FC≥Ⅲ级诊断效能最高,截断值为20.5%(AUC=0.914, P<0.001)。③相关性分析显示,RASr与RAA、NT-proBNP和TAPSE/sPAP有相关性( r=-0.803、-0.621、0.739,均 P<0.001)。 结论:轻度、中度及重度PH患者右心房功能受损程度依次加重;RASr诊断肺动脉高压患者WHO-FC≥Ⅲ级的效能最佳,是PH患者危险分层的潜在参数。

ObjectiveTo evaluate the right atrial volume and function abnormalities in patients with pulmonary hypertension(PH)by four-dimensional automatic quantitation technique,and to explore the application value of this technique in evaluating the risk stratification and World Health Organization functional class(WHO-FC)of PH patients.MethodsEighty-four adult patients with PH diagnosed by right heart catheterization from April to October 2022 in Fuwai Central China Cardiovascular Hospital were consecutively enrolled as the PH group.All cases were divided into 3 groups according to the mean pulmonary arterial pressure(mPAP):mild PH group(n=28),moderate PH group(n=28),severe PH group(n=28).Twenty-eight healthy volunteers matched by gender and age were included in the same period as the control group.The volume and strain parameters of the right atrium were obtained by analyzing the four-dimensional image of the right atrium using four-dimensional automatic quantitation technique,including right atrial minimum volume index(RAVImin),right atrial maximum volume index(RAVImax),right atrial presystolic volume index(RAVIpreA),right atrial ejection fraction(RAEF),right atrial passive ejection fraction(RAPEF),right atrial active ejection fraction,RAAEF,longitudinal strains of right atrial reserve,conduit and systolic period(RASr,RAScd,RASct),circumferential strains of right atrial reserve,conduit and systolic period(RASr-c,RAScd-c,RASct-c).The differences in right atrial parameters among four groups were compared.ROC curve was used to analyze the diagnostic efficiency of right atrial four-dimensional strain parameters for PH patients with WHO-FC≥Ⅲ.Pearson linear correlation analysis was used to investigate the relationships between RASr and right atrial area(RAA),NT-proBNP and tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure ratio(TAPSE/sPAP).Results①Compared with the control group,RAEF,RAPEF,RASr,RAScd,RASr-c,RAScd-c were significantly decreased in mild,moderate and severe PH groups;while RAAEF,RASct,RASct-c were significantly increased in mild PH group and significantly decreased in moderate and severe PH groups,and the differences were statistically significant(all P<0.05).RAVImin,RAVImax,RAVIpreA gradually increased among the control,mild PH,moderate PH and severe PH groups,and the differences were statistically significant(all P<0.05).RAEF,RAPEF,RAAEF,RASr,RAScd,RASct,RASr-c,RAScd-c,RASct-c were decreased successively among mild,moderate and severe PH groups,and the differences were statistically significant(all P<0.05).②ROC curve showed that RASr had the highest diagnostic efficiency in PH patients with WHO-FC≥Ⅲ,and the cut-off value was 20.5%(AUC=0.914,P<0.001).③Correlation analysis showed that RASr was correlated with RAA,NT-proBNP and TAPSE/sPAP(r=-0.803,-0.621,0.739;all P<0.001).ConclusionsThe degree of right atrial function impairment increased in patients with mild,moderate and severe PH in turn.RASr is the best predictor of WHO-FC≥Ⅲin patients with pulmonary hypertension and is a potential parameter for risk stratification in patients with PH.