超声二维应变成像与组织多普勒技术评价右心室纵向收缩功能的对比研究

目的 应用超声二维应变成像和组织多普勒(TDI)技术评价正常人及肺动脉高压患者右室纵向收缩功能,探讨二维应变定量评价心肌纵向收缩功能的应用价值.方法 肺动脉高压患者42例(PAH组),正常人31例(对照组),应用二维应变成像与TDI于心尖四腔观分别测量并计录右室游离壁基底段、中间段及心尖段纵向收缩峰值速度(V)、应变(ε)、应变率(SRS).并对两种测量方法 进行比较.结果 ①与对照组比较,PAH组TDI检测显示右室游离壁中间段ε、SRS值减低,差异均有统计学意义(P<0.05),基底段及心尖段ε、SRS值二组间差异无统计学意义(P>0.05);PAH组二维应变显示右室游离壁各节段ε、SRS测值均显著减低,差异有统计学意义(P均<0.05),而TDI及二维应变右室游离壁各节段V值差异无统计学意义(P>0.05).②与TDI测值比较,对照组内右室游离壁二维应变测值(V、ε、SRS)基底段、心尖段差异有统计学意义(P<0.05),中间段测值差异无统计学意义(P>0.05);PAH组内右室游离壁二维应变测值(V、ε、SRS)心尖段差异有统计学意义,基底段、中间段测值差异无统计学意义.③PAH组中两种测量方法 相关性良好(r=0.406～0.760,P均<0.05).结论 肺动脉高压患者的右室纵向收缩功能减低,二维应变可更准确、客观地评价右室长轴收缩功能.

Comparison of two-dimensional strain and tissue Doppler imaging based right ventricular longitudinal systolic function in normal subjects and patients with pulmonary arterial hypertension

Objective To assess right ventricular systolic function in normal subjects and patients with pulmonary arterial hypertension (PAH) by using 2-dimensional strain (2DS) and tissue Doppler imaging(TDI), and to investigate the feasibility of 2DS for quantitative assessment of myocardial longitudinal systolic function. Methods Longitudinal peak systolic velocity (V), peak systolic strain(ε), peak systolic strain rate(SRS) were measured in right ventricular free wall for basal,mid and apical segment in 42 patients with PAH and 31 healthy controls by 2DS and TDI from the apical 4-chamber view and compared between 2DS and TDI. Results ①Compared with controls,ε and SRS of the mid segment of the right ventricular free wall by TDI were significantly reduced in patients with PAH (P<0.05),but these of the basal and apical segment were normal (P>0.05). ε and SRS of all segments by 2DS were markedly reduced in patients with PAH (all P<0.05), V of all segments by TDI and 2DS were not decreased (P>0.05). ②In normal subjects,values(V,ε,SRS) of basal and apical segment of right ventricular free wall measured by 2DS were significantly different from those by TDI (P<0.05), Values of mid segment by 2DS and TDI were not significantly different (P>0.05); In patients with PAH, values (V, ε, SRS) of apical segment of right ventricular free wall by 2DS were significantly different from those by TDI,values of basal and mid segment by 2DS and TDI were not significantly different. ③ There were good correlations between 2DS and TDI in patients with PAH (r = 0.406～0.760, P<0.05 for all). Conclusions Right ventricular longitudinal systolic function in patients with PAH was decreased, 2DS is more accurate and objective than TDI in assessment of right ventricular longitudinal systolic function.