经胸实时三维超声心动图评估特发性肺动脉高压患者三尖瓣几何构型的价值

Tricuspid Valve Geom

目的:研究经胸实时三维超声心动图在评估特发性肺动脉高压(IPAH)患者的三尖瓣几何构型中的应用价值。方法:前瞻性入选2017年9月至2018年12月在中国医学科学院阜外医院就诊的IPAH患者30例(为IPAH组),健康志愿者15例为对照组。所有研究对象均行经胸二维及三维超声心动图检查,并使用四维自动三尖瓣定量(4D Auto-TVQ)在聚焦右心室切面分析三尖瓣结构。肺动脉高压患者均在超声心动图检查后48 h内采用右心导管检查确诊。结果:IPAH组的三尖瓣形态学参数瓣环面积、瓣环周长、四腔心直径、瓣叶结合点高度、幕状区最大高度和幕状区容积均显著大于对照组(P均<0.05)。与对照组相比,IPAH组瓣环收缩期位移明显更小(P<0.05)。两组的瓣环面积变化率和两腔心直径差异均无统计学意义(P均>0.05)。IPAH患者的三尖瓣幕状区最大高度和瓣叶接合点高度均与右心室舒张末期容积具有良好相关性(r=0.710、0.515,P均<0.05);瓣环周长、四腔心直径和瓣环面积均与右心房收缩末期容积具有良好相关性(r=0.712、0.558、0.545,P均<0.05)。结论:IPAH患者三尖瓣幕状区最大高度、瓣叶接合点高度和幕状区容积明显增大,三尖瓣环扩张主要体现在四腔心切面直径。三尖瓣幕状区高度与右心室容积相关,而三尖瓣环尺寸与右心房容积相关。

Objectives:To evaluate the tricuspid valve(TV)geometric remodeling in patients with idiopathic pulmonary arterial hypertension(IPAH)by three-dimensional transthoracic echocardiography.Methods:Two-dimensional and three-dimensional transthoracic echocardiography were performed in 30 IPAH patients and 15 healthy controls,and the geometry parameters of TV were obtained by four-dimensional auto tricuspid valve quantitative(4D Auto-TVQ)in the right ventricular-focused apical view.Pulmonary arterial hypertension was determined by right heart catheterization within 48 hours of echocardiography.Results:The 4-chamber diameter,tricuspid annular(TA)perimeter,TA area,maximal tenting height,coaptation point height and tenting volume were larger in IPAH patients than those in healthy controls(all P<0.05),2-chamber diameter was similar between two groups.In IPAH group,maximal tenting height and coaptation point height were moderately correlated with right ventricular end-diastolic volume(r=0.710,r=0.515,both P<0.05),while TA perimeter,4-chamber diameter and TA area were moderately correlated with right atrial end-systolic volume(r=0.712,r=0.558,r=0.545,all P<0.05).Conclusions:IPAH patients have larger maximal tenting height,coaptation point height and tenting volume,TA enlargement is mainly visible in 4-chamber diameter.TV tenting height is associated with right ventricular volume,but TA size is associated with right atrial volume in IPAH patients.