实时三维超声心动图及斑点追踪技术评价原发性肺动脉高压患者右心功能的研究

摘要

目的：探讨三维超声心动图及斑点追踪技术评价原发性肺动脉高压患者右心功能的价值。方法选取2013年10月至2014年6月在西安市中医医院确诊的60例原发性肺动脉高压患者，根据肺动脉收缩压(PASP)的高低分为轻度(PASP=35~50 mmHg)、中度(PASP=50~70 mmHg)和重度组(PASP≥70 mmHg)组，每组20例。另纳入20例年龄、性别匹配的健康人作为正常对照组。所有患者均行实时三维超声心动图检查。采集心尖四腔切面的二维及三维图像，连续采集三个心动周期。根据二维图像采用斑点追踪技术分析右室游离壁三尖瓣环收缩期峰值位移(T1)、室间隔三尖瓣环收缩期峰值位移(T2)、三尖瓣环连线中点收缩期峰值位移(Tm)和右室纵向缩短率(Tm%)。由三维图像分析右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室每搏输出量(RVSV)、右室射血分数(RVEF)等参数。结果肺动脉高压各组RVEDV和RVESV均高于正常组，而RVSV和RVEF均低于正常组，且均随病情严重程度呈逐渐恶化，组间比较差异均有统计学意义(P<0.05)。肺动脉高压各组的T1、T2、Tm和Tm%均低于正常组，且均表现为随病情加重而逐渐下降的趋势，组间比较差异均有统计学意义(P<0.05)。T1、T2、Tm和Tm%等三尖瓣环位移参数与RVEF呈明显正相关，相关系数分别为0.69、0.73、0.76和0.88(P<0.01)。结论实时三维超声心动图联合斑点追踪成像技术能有效评价原发性肺动脉高压患者右心室整体和局部的收缩舒张功能。%Objective To explore the value of real-time three-dimensional echocardiography combined with speckle tracking imaging technology in the evaluation of right ventricular systolic function of patients with pulmonary hypertension. Methods A total of 60 patients confirmed as primary pulmonary hypertension from October 2013 to June 2014 in Xi’an Hospital of Traditional Chinese Medicine were assigned into three groups according to pulmonary ar-tery systolic pressure (PASP): mild group (PASP=35~50 mmHg), moderate group (PASP=50~70 mmHg) and severe group (PASP≥70 mmHg), with 20 cases in each group. Twenty age-and sex-matched healthy individuals were enrolled as control group. All patients underwent real-time three-dimensional echocardiography. The two-dimensional and three-dimensional images of apical four-chamber view were collected for three consecutive cardiac cycles. Right ventric-ular free wall peak systolic displacement of the tricuspid annulus (T1), ventricular septal annulus peak systolic displace-ment (T2), tricuspid annular peak systolic displacement midpoint (Tm) and the right longitudinal ventricular shortening fraction (Tm%) were calculated form two-dimensional images by speckle tracking imaging technology;and right ventric-ular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVEF) were analyzed from three-dimensional images. Results The value of RVEDV and RVESV gradually increased with progression of pulmonary hypertension, which were significantly higher than those of the control group (P<0.05). The RVSV and RVEF gradually decreased with progression of pulmo-nary hypertension, which were significantly lower than those of the control group (P<0.05). The level of T1, T2, Tm and Tm% gradually declined with progression of pulmonary hypertension, which were significantly lower than those of the control group (P<0.05). There were positive correlation between the tricuspid annulus displacement parameters (T1, T2, Tm and Tm%) and RVEF (P<0.01), and the correlation coefficient was 0.69, 0.73, 0.76 and 0.88, respectively. Conclusion Real-time three-dimensional echocardiography combined with speckle tracking imaging technology was an effective method to evaluate right ventricular systolic and diastolic function of cardiopulmonary system disease.