肺动脉高压对左心室功能影响的超声研究

目的　探讨重度肺动脉高压时左心室功能改变及影响因素。方法　不明原因的重度肺动脉高压患者 4 7例 ,经食管超声心动图检查后分为先天性心脏病肺动脉高压组 (secondarypulmonary hypertention,SPH) 17例和原发性肺动脉高压组 (primary pulmonary hypertention,PPH) 30例 ,经胸超声心动图测量房室内径、左心室射血分数、偏心指数 (EI) ,多普勒超声心动图记录二尖瓣、肺静脉、左心室流入道和流出道交界处血流频谱。结果　与正常组比较 ,PPH组和 SPH组右心室舒张末期内径 (RVEDD)、右心房上下径 (RAL )、右心房横径 (RAT)增大 ,左心室舒张末期内径 (L VEDD)变小 ,收缩末期、舒张末期偏心指数 (EIs、EId)显著增大 ;E波、E/ A比值降低 ,舒张早期 E波减速时间(DT)延长 ;等容舒张时间 (IRT)、等容收缩时间 (ICT)延长 ,左心室射血时间 (ET)缩短 ,左心室 Tei指数增大。EIs、EId分别与 E、E/A呈负相关 ,与左心室 Tei指数呈正相关。结论　肺动脉高压患者存在左心室收缩和舒张功能障碍 ,左心室 Tei指数为反映左心室功能障碍的较好指标。

Study of the Effect of Pulmonary Hypertension on Left Ventricular Function

Objective To investigate the change of the left ventricular function and its underlying mechanism in patients with pulmonary hypertension.Methods Forty-seven patients with unexplained pulmonary hypertension were divided into two groups:pulmonary hypertension secondary to congenital heart disease group (SPH) and primary pulmonary hypertension group (PPH).Eccentric index was measured at the papillary muscle level at parasternal short-axis view.Mitral flow velocity pattern was recorded with the Doppler sample volume(PW) placed at the tips of the mitral leaflets.Left ventricular inflow and outflow velocity patterns were recorded with PW located at the junction of the left ventricular inflow and outflow tracts.Pulmonary venous flow wave was recorded with PW placed into the pulmonary vein at its junction with the left atrium.Results RVEDD,RAL,RAT,EIs and EId were larger,and LVEDD was smaller in patients with PPH and SPH than those in control subjects.E wave,E/A ratio were lower,DT,IRT,ICT was longer,ET was shorter,and left ventricular Tei index was larger in patients with PPH and SPH than those in the control subjects.There was a significant inverse correlation between EI and E,E/A in PPH and SPH groups.There was a significant positive correlation between EI and left ventricular Tei index.Conclusions Patients with severe pulmonary hypertension have left ventricular systolic and diastolic dysfunction.Left ventricular Tei index is a good index to estimate the left ventricular dysfunction.