平板运动负荷超声心动图对结缔组织病患者右心室收缩及收缩储备功能的评价

目的探讨平板运动负荷超声心动图（ESE）在无肺动脉高压（PAH）的结缔组织病（CTD）患者静息状态与运动后即刻右心室收缩功能及收缩储备功能评估中的应用价值。 方法选取2018年6月至2019年4月在四川省人民医院确诊为CTD且静息状态无PAH的患者29例（CTD组）及性别、年龄匹配的健康志愿者28例（对照组）。所有受试者均进行平板ESE检查，测量静息状态及运动后即刻右心室收缩功能参数：三尖瓣环收缩期峰值速度（s'）、右心室收缩期长轴峰值应变（S）及应变率（S-Sr）、右心室面积变化分数（FAC）、三尖瓣环收缩期位移（TAPSE），对比2组受试者运动后即刻与静息状态右心室收缩功能及收缩储备功能各参数的差异。 结果静息状态CTD组较对照组TAPSE、s'、S明显减低，差异均有统计学意义（P=0.0000、0.0001、0.0384），但2组的S-Sr和FAC差异均无统计学意义（P均＞0.05）；运动后2组各参数均较静息状态增加，但CTD组右心室收缩功能各参数均较对照组明显降低，差异均有统计学意义（P均＜0.05）。CTD组ΔTAPSE、Δs'、ΔFAC、ΔS、ΔS-Sr较对照组均明显降低，差异均有统计学意义（P均＜0.05）。 结论静息状态下无PAH的CTD患者右心室收缩功能及运动后右心室收缩储备功能明显受损。ESE作为一项简单、非侵入性的心脏功能检查方法有可能对静息状态无PAH的CTD患者右心室收缩功能及收缩储备功能受损进行早期诊断。

Assessment of right ventricular systolic function and contractile reserve in patients with connective tissue disease using treadmill exercise stress echocardiography

Objective To evaluate the value of treadmill exercise stress echocardiography(ESE) in the evaluation of right ventricular systolic function and contractile reserve in connective tissue disease(CTD)patients with normal resting pulmonary artery pressure.Methods Twenty-nine patients diagnosed with CTD without pulmonary arterial hypertension at rest in Sichuan Provincial People’s Hospital from June2018 to April 2019(CTD group)and 28 healthy sex-and age-matched controls(control group)were enrolled.All the subjects underwent treadmill ESE.Parameters of right ventricular systolic function were measured at rest and immediately post-exercise:pulsed tissue Doppler systolic velocity(s’),peak longitudinal systolic strain(S)and systolic strain rate(S-Sr),right ventricular fractional area change(FAC),and tricuspid annular plane systolic excursion(TAPSE).Those parameters were compared between the two groups at rest and postexercise.Results Atrest,TAPSE,s’,and S were significantly lower in the CTD group than in the control group(P=0.0000,0.0001,0.0384,P<0.05).There was no significant difference in S-Sr and FAC between the two groups at rest(P>0.05).s,S,S-Sr,FAC,and TAPSE were increased after exercise in both groups.All of those parameters were much lower in the CTD group than in the control group(P<0.05).Right ventricular contraction reserve parameters includingΔs’,ΔS-Sr,ΔTAPSE,ΔFAC,andΔS were much lower in the CTD group than in the control group(P<0.05).Conclusion The right ventricular systolic function and contractile reserve after exercise are significantly impaired in patients with connective tissue disease without resting PAH.Exercise stress echocardiography is a simple,non-invasive method for assessing cardiac function,and it may be used for early diagnosis of impaired right ventricular systolic dysfunction and contractile reserve in CTD patients without resting PAH.