斑点追踪显像评价法舒地尔对肺动脉高压患者右室收缩功能的影响

目的:应用斑点追踪显像(STI)技术定量分析肺动脉高压(PAH)患者右室游离壁及室间隔心肌收缩期峰值应变(S)和应变率(SR)及法舒地尔治疗对PAH患者右室收缩功能的影响.方法:PAH组17例,临床确诊为PAH且具有右心功能不全临床表现,超声心动图测量肺动脉收缩压( PASP)＞35 mm Hg.对照组20例,为年龄、性别相匹配的健康体检者.常规二维超声测量右房左右径(RA)、右室左右径(RV)、主肺动脉内径(MPA)、有室壁厚度(RVWT)及右室射血分数(RVEF).STI测量右室游离壁及室间隔基底段、中段收缩期峰值S、SR,比较上述参数在2组间有无差异,以及应用法舒地尔治疗前后PAH患者上述参数的变化.结果:(1)与对照组比较,PAH组RA、RV、MPA、RVWT均增大,RVEF减小(均P＜0.01),PAH组右室游离壁基底段、中段收缩期峰值S、SR,室间隔基底段、中段收缩期峰值S和室间隔基底段收缩期峰值SR均低于对照组(P＜0.05或P＜0.01).(2)PAH患者应用法舒地尔治疗2周后,PASP、RA、RV 降低(P＜0.O1),RVEF较用药前增高(P＜0.05),右室游离壁基底段、中段收缩期峰值S、SR及室间隔基底段、中段收缩期峰值S和室间隔基底段收缩期峰值SR较治疗前增加(P＜0.01或P＜0.05).结论:通过STI技术能敏感、准确地反映法舒地尔治疗前后PAH患者右室心肌收缩功能的改变情况,是评价PAH患者药物治疗效果的新方法.

The Effect of Fasudil on Right Ventricular Systolic Function Assessed by Speckle Tracking Imaging in Patients with Pulmonary Arterial Hypertension

Objective: To quantitatively analyse the peak systolic strain (S) and peak strain rate (SR) of the right ventricular free wall and ventricular septum in patients with pulmonary arterial hypertension (PAH) using speckle tracking imaging (STI),and to discuss the effect of fasudil on the right ventricular systolic function in PAH patients. Methods: Patients were divided into two groups in this study: PAH group (n=17) including PAH patients diagnosed by echocardiography (pulmonary artery systolic pressure, PASP>35 mm Hg) and gender and age-matched control group (n=20) including healthy volunteers assessed with echocardiography. The inner diameter of right atrium (RA), right ventricle (RV), main pulmonary artery (MPA), right ventricular wall thinkness (RVWT) and right ventricular ejection fraction (RVEF) were measured by a?conventional two-dimensional ultrasound?imaging system. The values of S and SR in the free wall of right ventricle and ventricular septum were measured and compared between two groups. These parameters were also compared after treatment with fasudil in PAH patients. Results: 1. Compared with control group, the values of RA, RV, MPA and RVWT were significantly increased, RVEF was decreased, in PAH group (P < 0.01). In PAH group, values of S and SR of basal and mid segments of free wall and basal segment of septum were lower than those in control group (P < 0.05 or P < 0.01). 2. The values of PASP, RA and RV were significantly decreased in PAH patients after treatment with fasudil for two weeks (P < 0.01). The value of RVEF was increased after treatment with fasudil compared with that before trearment (P < 0.05). Values of S and SR of basal, mid segments of free wall were increase after treatment with fasudil (P < 0.05 or P < 0.01). Conclusion: The speckle tracking imaging can assess the right ventricular systolic function in patients with pulmonary arterial hypertension, which is a new method to evaluate the drug treatment in PAH patients.