超声4D-RV-volume技术对原发性高血压患者右室收缩功能的评估价值

目的 探讨超声四维右心室容积定量分析(4D-RV-Volume)技术评估原发性高血压患者右室收缩功能的临床应用。方法 选择84例原发性高血压患者,按照左心室质量指数(LVMI)不同分为正常LVMI组(44例)和高LVMI组(40例),选择同期健康体检人员45例作为对照组,记录各组左室舒张末期内径(LVIDD )、左室收缩末期内径(LVESD)、左室后壁厚度(LVPWT)、室间隔厚度(IVST)、左室射血分数(LVEF)、三尖瓣环收缩期位移(TAPSE)、三尖瓣脉冲多普勒频谱舒张早、晚期峰值速度的比值(E/A)、肺动脉收缩压(PASP)和右室Tei指数,4D-RV-Volume技术获得右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室射血分数(RVEF)、右心室游离壁纵向应变率(RVFLS)、室间隔纵向应变率(RVSLS)、面积变化分数(RVFAC)等参数。结果 高LVMI组LVIDD、LVESD、LVPWT、IVST、RVEDV、RVESV均高于对照组(P<0.05),LVEF低于对照组(P<0.05)；高LVMI组TAPSE高于对照组和正常LVMI组(P<0.05)；对照组、正常LVMI组、高LVMI组E/A、RVFLS、RVFAC、RVEF呈降低趋势(P<0.05),PASP、右室Tei指数呈升高趋势(P<0.05)。RVSLS低于正常组和对照组(P<0.05)。RVEF值与右室Tei指数、PASP呈负相关(r=-0.513、-0.470,P<0.05),与TAPSE呈正相关(r=0.607,P<0.05)。4D-RV-Volume技术检测右心室RVEDV、RVESV、RVEF在不同观察者之间具有良好的一致性。结论 4D-RV-Volume技术可定量分析原发性高血压患者右心室结构和功能,为高血压患者病情评估和心血管并发症的防治提供依据。

The Value of 4D-RV-Volume in the Assessment of Right Ventricular Systolic Function in Patients with Essential Hypertension

Objective To investigate the clinical application of 4D-RV-Volume in the assessment of right ventricular systolic function in patients with essential hypertension. Methods 84 patients with essential hypertension were divided into normal LVMI group (44 cases) and high LVMI group (40 cases) according to different left ventricular mass index (LVMI), 45 health examiner were chosen as the control group, Left ventricular end diastolic diameter (LVIDD), left ventricular end systolic diameter (LVESD), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), tricuspid annulus systolic displacement (TAPSE), ratio of early to late peak velocity (E / a), pulmonary artery systolic pressure (PASP) and right ventricular Tei index were recorded. 4D-RV-Volume technique was used to obtain the parameters of right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV), right ventricular ejection fraction (RVEF), right ventricular free wall longitudinal strain rate (RVFLS), interventricular septal longitudinal strain rate (RVSLS), area change fraction (RVFAC). Results LVIDD, LVESD, LVPWT, IVST, RVEDV, RVESV of the high LVMI group were higher than those of the control group (P < 0.05), LVEF was lower than that of the control group (P < 0.05), TAPSE of the high LVMI group was higher than that of the control group and the normal LVMI group (P < 0.05), E / A, RVFLS, RVFAC, and RVEF of the control group, the normal LVMI group and the high LVMI group decreased (P < 0.05), PASP and Tei index increased (P < 0.05). RVSLS was lower than that of the normal group and the control group (P < 0.05). RVEF was negatively correlated with Tei index and PASP (r = -0.513, - 0.470, P < 0.05), and positively correlated with TAPSE (r = 0.607, P < 0.05). RVEDV, RVESV, and RVEF in the right ventricle showed good coherence by 4D-RV-Volume technique . Conclusion 4D-RV-Volume technique can be used to quantitatively analyze the structure and function of right ventricle in patients with essential hypertension, and it can provide evidence for the evaluation of hypertension and the prevention and treatment of cardiovascular complications.