斑点追踪技术评价肺动脉高压患者右心室形态及收缩功能的研究

目的：应用二维斑点追踪成像技术评价肺动脉高压患者右心室收缩功能，并与实时三维超声心动图进行对比研究。方法肺动脉高压患者31例，正常对照组33例，常规超声心动图测量各房室腔的大小、右心室游离壁厚度；二维斑点追踪成像技术获得右心室各个节段纵向应变、应变率及运动速度；应用实时三维超声心动图测量右心室射血分数。结果与对照组相比，肺动脉高压组右心室游离壁、室间隔基底段及中间段收缩期峰值运动速度较正常对照组减低（P〈0.05）；右心室各段收缩期应变除了心尖段外，其余各段较对照组减低（P〈0.05）；右心室应变率除室间隔侧心尖段外，其余各段差异均有统计学意义（P〈0.05）；右心室游离壁、室间隔收缩期峰值纵向应变平均值与肺动脉收缩压、三件瓣环收缩期位移、右心室射血分数有较好的相关性（P〈0.01）。结论斑点追踪成像技术各参数与多普勒超声心动图、三维超声心动图测量肺动脉收缩压及射血分数呈较好的相关性，为临床提供了一种新的方法评价肺动脉高压患者右心室收缩功能。

Assessment of right ventricular systolic function in patients with pulmonary hypertension using two dimensional speckle tracking imaging echocardiography

Objective To evaluate right ventricular systolic function with two dimensional speckle tracking imaging echocardiography in patients with pulmonary hypertension and compare with the results of real-time three-dimensional echocardiography. Methods This study included 31 cases of pulmonary hypertension patients and 33 healthy cases regarded as control group. Routine parameters such as the dimension of right ventricular, the thickness of right ventricular free wall and the maximal velocity of tricuspid valve regurgitation were measured by conventional echocardiography. Strain parameters such as the longitudinal strain, strain rate and movement speed of right ventricular various segments were measured by speckle tracking imaging echocardiography. Right ventricular ejection fraction was measured by real-time three-dimensional echocardiography. Results Compared with the control group, systolic peak velocity of right ventricular free wall, ventricular septal basal segment and the middle segment in pulmonary hypertension group was lower（P〈0.05）. Systolic strain and strain rate of right ventricular were lower than that of the control group;Systolic strain between every segment of right ventricular was statistically significant（P〈0.05）except the apical segment, right ventricular strain rate between two segments were statistically significant（P〈0.05）except apical segment of the interventricular septum side. Both average strain values of right ventricular free wall and interventricular septum were correlated with pulmonary artery systolic pressure and systolic displacement of tricuspid ring also correlated well with RVEF measured by speckle tracking imaging. Conclusion Speckle tracking imaging show a good correlation with routine doppler echocardiography measurement pulmonary artery systolic pressure and RVEF and would provide a new way to evaluate pulmonary hypertension.