采用实时三维超声和斑点追踪技术评价非酒精性脂肪性肝病肝硬化患者右心功能
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摘要
目的探讨采用实时三维超声(RT-3DE)和二维斑点追踪技术(2D-STI)检测评价非酒精性脂肪性肝病肝硬化患者右心功能变化的价值。方法 2015年2月～2016年11月诊治的非酒精性脂肪性肝病肝硬化患者70例,其中代偿期肝硬化35例,失代偿期肝硬化患者35例,选择同期健康志愿者35例作为对照组。采用RT-3DE测量右心房容积指数(RAVI),常规测量左心房前后径(LAD)、右心室舒张末内径(RVIDd)、右心室收缩末内径(RVIDs)、室间隔(IVS)和左心室后壁(LVPW),计算右心室面积变化分数(RVFAC)。测量三尖瓣口前向血流舒张早期E峰(ETV),运用脉冲多普勒超声成像测量三尖瓣环舒张早期峰值e'(e'TV),计算ETV/e'TV比值。采用M型超声测量三尖瓣环收缩期位移(TAPSE)。采用2D-STI技术测量右左心室收缩期右心房心肌平均峰值应变(MSs)、左心室舒张早期右心房心肌平均峰值应变(MSe)、左心室舒张晚期右心房心肌平均峰值应变(MSa),并获得左心室收缩期右心房心肌平均峰值应变率(MSRs)、左心室舒张早期右心房心肌平均峰值应变率(MSRe)和左心室舒张晚期右心房心肌平均峰值应变率(MSRa)。结果与健康人比较,代偿期肝硬化患者LAD、LVPW、ETV/e'TV升高,TAPSE降低(P<0.05);与失代偿期肝硬化患者比较,代偿期肝硬化患者RVIDs、IVS、LVPW、ETV/e'TV降低,TAPSE升高(P<0.05);与健康人比,代偿期肝硬化和失代偿期肝硬化患者RAV max、RAV min、RAV pre、RAVIa和RAVIt显著增大,而RAVIp显著减小,差异具有统计学意义(P<0.05);与失代偿期肝硬化患者比,代偿期肝硬化患者RAV max、RAV min、RAV pre、RAVIa和RAVIt显著减小,而RAVIp显著增大,差异具有统计学意义(P<0.05);与健康人比,代偿期肝硬化患者MSe、MSRs和MSRa显著增大,而MSRe和MSa显著减小,差异具有统计学意义(P<0.05);与失代偿期肝硬化患者比,代偿期肝硬化患者MSs、MSe、MSRs、MSRe和MSRa显著增大,而MSa显著减少,差异具有统计学意义(P<0.05)。结论借助RT-3DE和2D-STI技术检测可以敏感地反映非酒精性脂肪性肝病肝硬化患者左心功能状况,对早期正确评估心脏功能有极大的帮助。
Objective To evaluate right atrial and ventricular functions in patients with nonalcoholic fatty liver disease(NAFLD)-induced liver cirrhosis(LC) by real-time three-dimensional echocardiography(RT-3DE)and speckle tracking imaging(2D-STI). Methods 70 patients(compensated in 35 and decompensated in 35)with NAFLD-induced LC and 35 healthy persons were recruited in our hospital between February 2015 and November 2016. The RAVI,LAD,RVIDd,RVIDs,IVS and LVPW were obtained by RT-3DE,and the RVFAC was calculated. The ETV and e'TV were measured and the ratio of ETV/e'TV was calculated. The TAPSE was obtained by M mode echocardiography. The MSs,MSe,MSa,MSRs,MSRe and MSRa were also measured by 2D-STI. Results The LAD,LVPW and ETV/e'TV in patients with compensated cirrhosis decreased as compared to those in healthy persons(P <0.05);the RVIDs,IVS,LVPW and ETV/e'TV in patients with compensated cirrhosis decreased as compared to those in patients with decompensated cirrhosis(P<0.05);the RAV max,RAV min,RAV pre,RAVIa and RAVIt in patients with liver cirrhosis significantly increased,while the RAVIp decreased as compared to those in control(P<0.05);the RAV max,RAV min,RAV pre,RAVIa and RAVIt in patients with compensated cirrhosis significantly decreased,while the RAVIp increased as compared to those in patients with decompensated cirrhosis(P <0.05);the MSe,MSRs and MSRa in patients with liver cirrhosis significantly increased,while the MSRe and MSa decreased as compared to those in control(P<0.05);the MSs,MSe,MSRs,MSRe and MSRa in patients with compensated cirrhosis significantly increased,while the MSa decreased in patients with decompensated cirrhosis(P<0.05). Conclusion The application of RT-3DE and 2D-STI in evaluating right atrial and ventricular functions in patients with NAFLD-induced LC might be helpful for clinicians to early predict the cardiac deficiency,which needs further investigations.
Objective To evaluate right atrial and ventricular functions in patients with nonalcoholic fatty liver disease(NAFLD)-induced liver cirrhosis(LC) by real-time three-dimensional echocardiography(RT-3DE)and speckle tracking imaging(2D-STI). Methods 70 patients(compensated in 35 and decompensated in 35)with NAFLD-induced LC and 35 healthy persons were recruited in our hospital between February 2015 and November 2016. The RAVI,LAD,RVIDd,RVIDs,IVS and LVPW were obtained by RT-3DE,and the RVFAC was calculated. The ETV and e'TV were measured and the ratio of ETV/e'TV was calculated. The TAPSE was obtained by M mode echocardiography. The MSs,MSe,MSa,MSRs,MSRe and MSRa were also measured by 2D-STI. Results The LAD,LVPW and ETV/e'TV in patients with compensated cirrhosis decreased as compared to those in healthy persons(P <0.05);the RVIDs,IVS,LVPW and ETV/e'TV in patients with compensated cirrhosis decreased as compared to those in patients with decompensated cirrhosis(P<0.05);the RAV max,RAV min,RAV pre,RAVIa and RAVIt in patients with liver cirrhosis significantly increased,while the RAVIp decreased as compared to those in control(P<0.05);the RAV max,RAV min,RAV pre,RAVIa and RAVIt in patients with compensated cirrhosis significantly decreased,while the RAVIp increased as compared to those in patients with decompensated cirrhosis(P <0.05);the MSe,MSRs and MSRa in patients with liver cirrhosis significantly increased,while the MSRe and MSa decreased as compared to those in control(P<0.05);the MSs,MSe,MSRs,MSRe and MSRa in patients with compensated cirrhosis significantly increased,while the MSa decreased in patients with decompensated cirrhosis(P<0.05). Conclusion The application of RT-3DE and 2D-STI in evaluating right atrial and ventricular functions in patients with NAFLD-induced LC might be helpful for clinicians to early predict the cardiac deficiency,which needs further investigations.
引文
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[14]Woo JS,Yu TK,Kim WS,et al.Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging.J Geriatr Cardiol,2015,12(5):474-481.
[15]Ran H,Zhang PY,Fang LL,et al.Clinic value of two-dimensional speckle tracking combined with adenosine stress echocardiography for assessment of myocardial viability.E-chocardiography,2012,29(6):688-694.
[16]Abd ERM,Raedle-Hurst T,Rentzsch A,et al.Assessment of inter-atrial,inter-ventricular,and atrio-ventricular interactions in tetralogy of fallot patients after surgical correction.Insights from two-dimensional speckle tracking and three-dimensional echocardiography.Cardiol Young 2015,25(7):1254-1262.
[17]曹省,陈金玲,周青,等.二维斑点追踪显像技术评价阵发性心房颤动患者左心房功能和同步性的研究中华超声影像学杂志,2013,22(3):194-198.
[18]陈金玲,郭瑞强,姜凤霞,等.超声对充血性心力衰竭患者再同步化治疗术后舒张功能改善的评价.中华超声影像学杂志,2013,22(1):17-20.
[19]Rudski LG,Lai WW,Afilalo J,et al.Guidelines for the echocardiographic assessment of the right heart in adults:a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography,a registered branch of the European Society of Cardiology,and the Canadian Society of E-chocardiography.J Am Soc Echocardiogr,2010,23(7):685-713.
[2]Naqvi IH,Mahmood K,Naeem M,et al.The heart matters when the liver shatters!Cirrhotic cardiomyopathy:frequency,comparison,and correlation with severity of disease.Prz Gastroenterol,2016,11(4):247-256.
[3]Gaynor SL,Maniar HS,Prasad SM,et al.Reservoir and conduit function of right atrium:impact on right ventricular filling and cardiac output.Am J Physiol Heart Circ Physiol,2005,288(5):H2140.
[4]孟祥丽,李一丹,李虹,等.肺动脉高压患者右心房容积和时相功能变化及其临床价值的研究.中华超声影像学杂志,2017,26(10):325-328.
[5]Liew R,Catanchin A,Behr ER,et al.Use of non-contact mapping in the treatment of right atrial tachycardias in patients with and without congenital heart disease.Europace,2008,10(8):972-981.
[6]Chen Y,Chan AC,Chan SC,et al.A detailed evaluation of cardiac function in cirrhotic patients and its alteration with or without liver transplantation.J Cardiol,2016,67(2):140-146.
[7]Nazar A,Guevara M,Sitges M,et al.LEFT ventricular function assessed by echocardiography in cirrhosis:relationship to systemic hemodynamics and renal dysfunction.J Hepatol,2013,58(1):51-57.
[8]Papastergiou V,Skorda L,Lisgos P,et al.Ultrasonographic prevalence and factors predicting left ventricular diastolic dysfunction in patients with liver cirrhosis:is there a correlation between the grade of diastolic dysfunction and the grade of liver disease Sci World J,2012(6):615057.
[9]Anwar AM,Nosir YF,Ajam A,et al.Central role of real-time three-dimensional echocardiography in the assessment of intracardiac thrombi.Int J Cardiovasc Imaging,2010,26(5):519-526.
[10]Rohner A,Brinkert M,Kawel N,et al.Functional assessment of the left atrium by real-time three-dimensional echocardiography using a novel dedicated analysis tool:initial validation studies in comparison with computed tomography.Eur J Echocardiogr,2011,12(7):497-505.
[11]Kim MY,Baik SK.Hyperdynamic circulation in patients with liver cirrhosis and portal hypertension.Korean J Gastroenterol,2009,54(3):143.
[12]Kim SK,Shin WJ,Kim JW,et al.Prediction of hyperdynamic circulation by arterial diastolic reflected waveform analysis in patients undergoing liver transplantation.Blood Press Monit,2015,21(1):9.
[13]姚雪,朱静静,朱萍,等.二维斑点追踪纵向应变评价急性左心室下壁合并右心室心肌梗死患者右心室收缩功能.中华超声影像学杂志,2015,24(11):936-941.
[14]Woo JS,Yu TK,Kim WS,et al.Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging.J Geriatr Cardiol,2015,12(5):474-481.
[15]Ran H,Zhang PY,Fang LL,et al.Clinic value of two-dimensional speckle tracking combined with adenosine stress echocardiography for assessment of myocardial viability.E-chocardiography,2012,29(6):688-694.
[16]Abd ERM,Raedle-Hurst T,Rentzsch A,et al.Assessment of inter-atrial,inter-ventricular,and atrio-ventricular interactions in tetralogy of fallot patients after surgical correction.Insights from two-dimensional speckle tracking and three-dimensional echocardiography.Cardiol Young 2015,25(7):1254-1262.
[17]曹省,陈金玲,周青,等.二维斑点追踪显像技术评价阵发性心房颤动患者左心房功能和同步性的研究中华超声影像学杂志,2013,22(3):194-198.
[18]陈金玲,郭瑞强,姜凤霞,等.超声对充血性心力衰竭患者再同步化治疗术后舒张功能改善的评价.中华超声影像学杂志,2013,22(1):17-20.
[19]Rudski LG,Lai WW,Afilalo J,et al.Guidelines for the echocardiographic assessment of the right heart in adults:a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography,a registered branch of the European Society of Cardiology,and the Canadian Society of E-chocardiography.J Am Soc Echocardiogr,2010,23(7):685-713.