组织多普勒成像测量三尖瓣环等容收缩期峰值速度在评价肺高压患者右心功能中的应用

目的探讨组织多普勒成像（TDI）技术测量三尖瓣环等容收缩期峰值速度（IVCv）评价肺动脉高压（PH）患者右心功能的可行性和临床价值。方法对41例疑诊PH患者采用组织多普勒测量IVCv，同时超声检测右心收缩功能常用参数：右心室侧壁三尖瓣环平面位移（TAPsE）、右心室侧壁三尖瓣环收缩期峰值运动速度（PSv）、右心室面积变化率（RVFCA）。另外，右心导管（RHC）检测肺动脉压力。根据肺动脉收缩压（PASP）将患者分为无PH组，轻度PH组，中度PH组，重度PH组4组，比较各组之间IVCv是否存在差异，受试者操作特性（ROC）曲线分析IVCv对右心功能评价的敏感度和特异度，以及IVCv与常用右心收缩功能参数和肺动脉压力的相关性。结果IVCv与TAPSE、PSv、RVFAC呈正相关，r值分别为0．341、0．714、0．557，P值均〈O．001。IVCv与PASP呈负相关，，值为一O．739，P〈0．05。无PH组、轻度PH组、中度PH组、重度PH组的IVCv分别为（13．83±3．56）cm／s、（10．11±1．36）cm／s、（8．70±2．21）cm／s、（5．80±1．03）cm／s。重度PH组IVCv显著低于中度、轻度及无PH组（P值均〈0．05），无PH组IVCv显著高于轻度、中度PH组（P值均〈0．01）；轻度PH组与中度PH组IVCv差异无统计学意义（尸〉0．05）。以常用的超声心动图评估右心室收缩功能参数的低限（TAPSE〈16mm，PSv〈10crn／s，RVFA〈35％）为标准，选用IVCv〈6．5cm／s作为阈值，诊断右心室收缩功能减低的敏感度分别是91％、96％、87％，特异度分别是70％、53％、77％。结论组织多普勒测量三尖瓣环等容收缩期峰值速度是一项较新、能客观反映右心室收缩功能的参数，值得进一步研究应用。

Measuring isovolumic contraction peak velocity at the tricuspid annulus by Doppler tissue imaging to assess right heart function in patients with pulmonary hypertension

Objective To evaluate the feasibility and accuracy of the isovolumic contraction peak velocity （IVCv） of right heart function in patients with pulmonary hypertension （PH） by echocardiography and Doppler tissue imaging. Methods In 41 patients with suspected diagnosis ofPH, IVCv at the tricuspid annulus were measured by echocardiography and Doppler tissue imaging. The right heart systolic function parameters such as tricuspid annular plane systolic excursion （TAPSE）, peak systolic velocity （PSv） and right ventricular fractional area change （RVFCA） were also measured. The pulmonary artery pressure was detected by right-heart catheterization （RHC）. According to different levels of pulmonary arterial systolic pressure, patients were classified into four groups to compare and analyze if any significance could be found, including without PH group, mild PH group, moderate PH group and severe PH group. The sensitivity and specificity for diagnosing right heart impairment were assessed by ROC curves. Last, correlation analysis was performed. Results IVCv was significantly and positively correlated with the right heart systolic function parameters, such as TAPSE （r =0.557,P 〈 0.001）, PSv （r =0.714, P 〈 0.001） and RVFCA （r =0.341, P 〈 0.05）. Negative correlation existed between 1VCv and PASP （r =-0.739, P 〈 0.001）. The average 1VCv of without PH group, mild PH group, moderate PH group and severe PH group were （13.83 ±3.56） cm/s, （10.11±1.36） cm/s, （8.70±2.21） cm/s and （5.80±1.03） cm/s, respectively. The level of IVCv was obviously lower in severe PH group than those in without PH group, mild PH group and moderate PH group. The difference was significant （P 〈 0.05）. The levels of IVCv increased obviously in without PH group than those in mild PH group and moderate PH group （P 〈 0.01）. There were no differences for IVCv between mild PH group and moderate PH group （P 〉 0.05）. Using the lower limit of right ventricular systofic function parameter obtained by common echocardiographic assessment as standard （TAPSE＇〈 16 mm, PSv 〈 10 cm/s and RVFAC 〈 35%）, the sensitivities of IVCv 〈 6.5 cm/s for diagnosing right ventricular systolic function reduction were 91%, 96% and 87% and the specificities were 70%, 53% and 77%, respectively. Conclusions IVCv obtained by Doppler tissue imaging is a new objective parameter for diagnosing right venlricular systolic function reduction. It is worth further study and application in clinic.