应变率成像评估肺动脉高压右心室心肌机械运动不同步的研究

目的探讨应变率成像（SRI）评估肺动脉高压（PH）患者右心室心肌机械运动不同步的价值。方法应用SRI定量检测36例PH患者（PH组）及35例健康受检者（对照组），观察右心室6节段及右心室整体心肌非同步相关参数，包括：QRS波至右心室6节段及右心室整体心肌收缩期达峰时间（Ts）、右心室机械不同步指数（RV—DI），并对所获参数进行心率校正；测量右心室功能相关参数：右心室面积变化分数（RVFAC）、右心室MPI指数（RVMPI）、右心室游离壁三尖辩环收缩期位移（TAPSE）、右心室射血分数（RVEF）、右心宣整体应变率（RV Strain）及右心室整体收缩期峰值应变（RV Sas）。结果PH组RV—DI、右心室整体Ts大于对照组（P〈0．05），右心室游离壁基底段殁中间段Ts长于室间隔相应节段TB及对照组相应节段Ts（P〈0．05）；PH组右心室功能相关参数均低于对照组（P〈0．01）；RV-DI与RVFAC及RVEF呈负相关（r=-0．81，P〈0．05；r=-0．85，P〈0．01）。结论PH患者存在右心室机械运动不同步，SRI可作为临床判断右心室机械不同步重要方法。

Evaluation of Right Ventricular Mechanical Dyssynchrony with Strain Rate Lmaging in Patients with Pulmonary Arterial Hypertension

Objective To evaluate right ventricular （RV） mechanical dyssynchrony with strain rate imaging （SRI） in patients with pulmonary arterial hypertension （PH）. Methods RV mechanical dyssynchrony parameters including QRS to global and segmental peak systolic velocity interval （Ts） and RV dyssynchrony index （RV-DI） were measured from six segments of RV in four-chamber view in thirty-six patients with PH and thirty-five controls. All the time intervals were corrected by heart rate. The parameters reflect RV function including RV fractional area change（RVFAC）, RV myocardial performance index（RVMPI） ,tricuspid annular plane excursion（TAPSE）, RV ejection fraction（ RVEF）, RV global strain rate（ RV strain）and RV global peak systolic strain（ RV SRs）were measured. Results RV DI and RV global Ts significantly higher in patients with PH compared with controls（ P 〈 0.05 ）. Ts of basal and mid segments of RV free wall were significantly longer than the same segments of ventricle septal in the patients with PH, and Ts of basal and mid segments of RV free wall were significantly longer than the same segments in patients with PH compared with controls（ P 〈0.05 ）. The parameters of RV function were significantly lower those in patients with PH compared with controls（P 〈 0.01 ）. RV-DI had negative correlation with RVFAC and RVEF （ r = - 0.81, P 〈 0. 05 ; r = - 0.85, P 〈 0.01 ）. Conclusion Patients with PH have RV mechanical dyssynchrony, which can be well estimated by SRI for clinical use.