斑点追踪显像评价肺动脉高压患者右心室整体纵向功能的临床研究

目的 应用斑点追踪显像技术评价肺动脉高压患者右心室整体纵向功能.方法 正常对照组31例;肺动脉高压患者42例,根据肺动脉收缩压程度将其分为轻度(17例)、中度(15例)、重度(10例)三组.获取心尖四腔观,应用二维超声斑点追踪显像技术测量并比较各组右室整体纵向收缩期峰值应变(GLS)、收缩期峰值应变率(GLSRs)、舒张早期峰值应变率(GLSRe)、舒张晚期峰值应变率(GLSRa),分析影响肺动脉高压患者右室整体纵向功能的指标.结果 轻、中、重度肺动脉高压患者右室GLS、GLSRs、GLSRe、GLSRa均较对照组显著减低,差异有统计学意义(均P<0.05),且重度肺动脉高压患者右室GLS较轻度者显著减低,差异有统计学意义(P<0.05),轻、中、重度肺动脉高压患者之间右室GLSRs、GLSRe、GLSRa差异无统计学意义(P>0.05),肺血管阻力和肺动脉收缩压是影响肺动脉高压患者右室整体纵向收缩功能的决定因素(r=-0.466～-0.549,r=-0.403～-0.425,均P<0.05),三尖瓣环收缩峰值速度与肺动脉高压患者右室GLS、GLSRs有良好的相关性(r=0.556～0.585,P<0.001).结论 肺动脉高压患者的右室整体功能减低,斑点追踪显像技术可准确、客观地评价右室整体纵向功能.

Clinical study of right ventricular global longitudinal function in patients with pulmonary arterial hypertension by 2-dimensional ultrasound speckle tracking imaging

Objective To assess right ventricular(RV) global longitudinal function in patients with pulmonary arterial hypertension (PAH) by 2-dimensional ultrasound speckle tracking imaging (STI). Methods According to pulmonary artery systolic pressure, 42 patients with PAH were divided into mild (17) ,moderate(15) and severe(10) PAH groups. RV global longitudinal peak systolic strain (GLS), strain rate(GLSRs) ,early diastolic strain rate (GLSRe) and late diastolic strain rate (GLSRa) were measured in 42 patients with PAH and 31 healthy controls by STI from the apical 4-chamber view and compared between groups and assessed the determinants of the RV global longitudinal functional parameters. Results Right ventricular GLS,GLSRs,GLSRe, GLSRa were significantly impaired in patients with PAH compared with controls (P<0.05 for all). Right ventricular GLS were most altered in patients with the severe PAH group compared with mild PAH patients (P<0. 05). Right ventricular GLSRs, GLSRe, GLSRa were not significant between mild,moderate and severe PAH groups(P>0.05). Pulmonary vascular resistance and pulmonary artery systolic pressure were the determinants of RV global longitudinal systolic function(r= - 0.466～- 0. 549, r = - 0. 403～- 0. 425, respectively, P <0.05 for both). There were good correlations between tricuspid annular systolic peak velocity and RV GLS,GLSRs in patients with PAH (r = 0. 556～0. 585, P < 0.001). Conclusions RV global function decreases in patients with PAH, RV global longitudinal function can be accurately and objectively studied by STI.