斑点追踪技术测量三尖瓣环位移评价右心室收缩功能的临床研究

目的 应用超声二维斑点追踪技术测定三尖瓣环收缩期位移(TAD),并分析其与右室射血分数(RVEF)之间的相关性,旨在为评价右室收缩功能寻找一种便捷、实用的新方法.方法 研究对象为24例健康志愿者(对照组)及16例充血性心力衰竭患者(心衰组,其中扩张型心肌病13例,缺血型心肌病3例),记录心尖四腔观二维图像并输入Qlab 6.0工作站自动测量右室游离壁处三尖瓣环收缩期峰值位移(TADla)、三尖瓣环连线中点处收缩期峰值位移(TADmid).应用实时三维超声心动图计算RVEF,并分析TAD参数与RVEF之间的关系.结果 40例受检者TADla平均(19.3±5.9)mm(7.8～28.4 mm),TADmid平均(15.3±4.6)mm(7.2～22.2 mm).与对照组比较,心衰组各参数均显著降低(P<0.01);TADla、TADmid与RVEF显著正相关,相关系数分别为0.87和0.91,直线相关方程分别为RVEF=2.2 TADla + 9.9和RVEF=3.0TADmid+7.1.TADla评价RVEF<45%的截断点值为17.2 mm,敏感性为89%,特异性为93%;TADmid评价RVEF<45%的截断点值为13.1 mm,敏感性为96%,特异性为100%.结论 超声二维斑点追踪技术测定的TAD与RVEF之间存在良好的相关性,有望成为临床常规评价右室整体收缩功能的新方法.

Evaluation of right ventricular systolic function by measurement of tricuspid annular displacement with speckle tracking imaging

Objective To explore the value of peak systolic displacement of tricuspid annulus(TAD)in evaluation of right ventricular systolic function by speckle tracking imaging(STI).Methods The study population consisted of 24 healthy subjects(control group)and 16 patients with congestive heart failure(CHF).The apical four-chamber view was obtained and imput to Qlab 6.0 workstation. The TAD at the right ventricular free wall (TADla)and the midpoint of tricuspid annulus(TADmid)were measured and calculated automatically.Right ventricular ejection fraction(RVEF)was measured by real-time three-dimensional echocardiography.The correlation of displacement parameters with RVEF was analyzed.Results In all 40 subjects, the mean value of TADla was(19.3±5.9)mm with s range from 7.8 to 28.4 mm while the mean value of TADmid was(15.3±4.6)mm with a ranging from 7.2 to 22.2 mm.The parameters in CHF group were significantly lower than those of the control group(P<0.01).TADla and TADmid showed an excellent correlation with RVEF(r=0.87 and 0.91 respectively,P<0.01).The cut-off value of TADla for RVEF<45%was 17.2 mm with a sensitivity of 89%and a specificity of 93% while the cut-off value of TADmid for RVEF<45% was 13.1 mm with a sensitivity of 96%and a specificity of 1 00%.Conclusions TAD by STI showed an excellent correlation with RVEF, and it may be a new promising method for routine evaluation of right ventricular systolic function.