实时三维超声心动图评价肺动脉高压患者右心结构及血流动力学的价值
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摘要
目的探讨实时三维超声心动图(RT-3DE)评价肺动脉高压(PH)患者右心结构及血流动力学的价值。方法选取2014年7月至2016年12月江苏省苏北人民医院收治的PH患者89例。另选取同期健康体检者49名作为健康对照组。根据肺动脉收缩压(PASP)将89例PH患者分为轻度PH29例、中度PH32例和重度PH28例。采用RT-3DE测量所有受检者右心结构相关参数,包括右心室横径(RVTD)、左心室横径(LVTD)、右心室整体舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、右心室射血分数(RVEF)及血流动力学参数,包括肺动脉收缩压(SPAP)、肺动脉舒张压(DPAP)、肺动脉平均压(MPAP)、右心输出量(RCO)。采用独立样本t检验比较PH组患者与健康对照组受检者右心结构相关参数、血流动力学参数差异;采用方差分析比较不同程度PH组患者右心结构相关参数、血流动力学参数差异,进一步组间两两比较采用SNK-q检验。结果 PH组患者RVTD、EDV、ESV均高于健康对照组受检者,而LVTD、SV、RVEF均低于健康对照组受检者,且差异均有统计学意义(t=-2.73,P=0.003;t=-4.37,P=0.001;t=-4.57,P=0.002;t=-3.49,P=0.039;t=-2.01,P=0.043;t=6.36,P=0.001)。中度PH组、重度PH组患者RVTD、EDV、ESV均高于轻度PH组患者,而LVTD、SV、RVEF均低于轻度PH组患者,且差异均有统计学意义(q=4.318、4.713、3.873、3.921、5.127、5.347、5.618、5.903、4.318、4.501、5.327、5.981,P均<0.05);重度PH组患者LVTD、EDV、ESV、SV、RVEF均低于中度PH组患者,RVTD高于中度PH组患者,且差异均有统计学意义(q=3.708、3.249、4.807、3.953、3.197、3.764,P均<0.05)。PH组患者SPAP、DPAP、MPAP均高于健康对照组受检者,而RCO低于健康对照组受检者,且差异均有统计学意义(t=0.637,P=0.001;t=0.875,P=0.001;t=0.783,P=0.001;t=0.691,P=0.035)。中度PH组、重度PH组患者SPAP、DPAP、MPAP均高于轻度PH组患者,重度PH组SPAP高于中度PH组患者,且差异均有统计学意义(q=4.349,P=0.041;q=5.871,P=0.039;q=4.201,P=0.042;q=4.869,P=0.043;q=3.981,P=0.034;q=3.991,P=0.035;q=0.421,P=0.039),而中度PH组与重度PH组患者DPAP、MPAP差异无统计学意义;而RCO在轻度PH组、中度PH组、重度PH组患者呈逐渐下降趋势,且任意两组间差异均有统计学意义(q=3.541,P=0.033;q=3.204,P=0.030;q=0.391,P=0.043)。结论 PH患者右心功能减低,RT-3DE可准确评价不同程度PH患者右心功能。
Objective To explore the value of real-time three-dimensional echocardiography(RT-3 DE) in evaluating right ventricular structure and hemodynamic parameters of patients with pulmonary hypertension(PH). Methods A total of 89 PH patients in Subei People′s Hospital from July 2014 to December 2016 were selected as PH group, and 49 subjects with health examination were designed as control group. According to pulmonary arterial systolic pressure(PASP), the 89 patients with PH were divided into mild PH group(n=29), moderate PH group(n=32) and severe PH group(n=28). The indexes of right heart structure such as right ventricular diameter(RVTD), left ventricular diameter(LVTD), right ventricular end diastolic volume(EDV), end systolic volume(ESV), stroke volume(SV) and right ventricular ejection fraction(RVEF) as well as hemodynamic parameters such as pulmonary systolic pressure(SPAP), pulmonary artery diastolic pressure(DPAP), mean pulmonary artery pressure(MPAP) and right ventricular output(RCO) were detected by RT-3 DE in all the subjects. The indexes of right heart structure and hemodynamic parameters were compared by independent-sample t test between PH group and control group, and indexes of right heart structure and hemodynamic parameters were compared by variance analysis among different PH groups. The SNK-q test was used for the further comparison between any two groups. Results The RVTD, EDV and ESV in the PH group were significantly higher than those in the control group, while LVTD, SV and RVEF were significantly lower than those in the control group(t=-2.73, P=0.003; t=-4.37, P=0.001; t=-4.57, P=0.002; t=-3.49, P=0.039; t=-2.01, P=0.043; t=6.36, P=0.001). The RVTD, EDV and ESV in moderate PH group and severe PH group were significantly higher than those in the mild PH group, while the LVTD, SV and RVEF were significantly lower than those in the mild PH group(q=4.318, 4.713, 3.873, 3.921, 5.127, 5.347, 5.618, 5.903, 4.318, 4.501, 5.327, 5.981, all P < 0.05). The LVTD, EDV, ESV, SV, RVEF in the severe PH group were significantly lower than those in the moderate PH group, while the RVTD was significantly higher than the moderate PH group(q=3.708, 3.249, 4.807, 3.953, 3.197, 3.764, all P < 0.05). The SPAP, DPAP and MPAP in PH group were significantly higher than those in control group, while RCO was significantly lower than that that in the control group(t=0.637, P=0.001; t=0.875, P=0.001; t=0.783, P=0.001; t=0.691, P=0.035). The SPAP, DPAP and MPAP in moderate PH group and severe PH group were significantly higher than those in the mild PH group, and the SPAP in the severe PH group was significantly higher than that in the moderate PH group(q=4.349, P=0.041; q=5.871, P=0.039; q=4.201, P=0.042; q=4.869, P=0.043; q=3.981, P=0.034; q=3.991, P=0.035; q=0.421, P=0.039). There were no significant differences in DPAP and MPAP between the moderate PH group and the severe PH group. The RCO decreased gradually in the mild PH group, the moderate PH group and the severe PH group, and there were significant differences between any two groups(q=3.541, P=0.033; q=3.204, P=0.030; q=0.391, P=0.043). Conclusion In PH patients, the right ventricular function declined, and RT-3 DE can accurately evaluate the right ventricular function in patients with different degrees of pulmonary hypertension.
Objective To explore the value of real-time three-dimensional echocardiography(RT-3 DE) in evaluating right ventricular structure and hemodynamic parameters of patients with pulmonary hypertension(PH). Methods A total of 89 PH patients in Subei People′s Hospital from July 2014 to December 2016 were selected as PH group, and 49 subjects with health examination were designed as control group. According to pulmonary arterial systolic pressure(PASP), the 89 patients with PH were divided into mild PH group(n=29), moderate PH group(n=32) and severe PH group(n=28). The indexes of right heart structure such as right ventricular diameter(RVTD), left ventricular diameter(LVTD), right ventricular end diastolic volume(EDV), end systolic volume(ESV), stroke volume(SV) and right ventricular ejection fraction(RVEF) as well as hemodynamic parameters such as pulmonary systolic pressure(SPAP), pulmonary artery diastolic pressure(DPAP), mean pulmonary artery pressure(MPAP) and right ventricular output(RCO) were detected by RT-3 DE in all the subjects. The indexes of right heart structure and hemodynamic parameters were compared by independent-sample t test between PH group and control group, and indexes of right heart structure and hemodynamic parameters were compared by variance analysis among different PH groups. The SNK-q test was used for the further comparison between any two groups. Results The RVTD, EDV and ESV in the PH group were significantly higher than those in the control group, while LVTD, SV and RVEF were significantly lower than those in the control group(t=-2.73, P=0.003; t=-4.37, P=0.001; t=-4.57, P=0.002; t=-3.49, P=0.039; t=-2.01, P=0.043; t=6.36, P=0.001). The RVTD, EDV and ESV in moderate PH group and severe PH group were significantly higher than those in the mild PH group, while the LVTD, SV and RVEF were significantly lower than those in the mild PH group(q=4.318, 4.713, 3.873, 3.921, 5.127, 5.347, 5.618, 5.903, 4.318, 4.501, 5.327, 5.981, all P < 0.05). The LVTD, EDV, ESV, SV, RVEF in the severe PH group were significantly lower than those in the moderate PH group, while the RVTD was significantly higher than the moderate PH group(q=3.708, 3.249, 4.807, 3.953, 3.197, 3.764, all P < 0.05). The SPAP, DPAP and MPAP in PH group were significantly higher than those in control group, while RCO was significantly lower than that that in the control group(t=0.637, P=0.001; t=0.875, P=0.001; t=0.783, P=0.001; t=0.691, P=0.035). The SPAP, DPAP and MPAP in moderate PH group and severe PH group were significantly higher than those in the mild PH group, and the SPAP in the severe PH group was significantly higher than that in the moderate PH group(q=4.349, P=0.041; q=5.871, P=0.039; q=4.201, P=0.042; q=4.869, P=0.043; q=3.981, P=0.034; q=3.991, P=0.035; q=0.421, P=0.039). There were no significant differences in DPAP and MPAP between the moderate PH group and the severe PH group. The RCO decreased gradually in the mild PH group, the moderate PH group and the severe PH group, and there were significant differences between any two groups(q=3.541, P=0.033; q=3.204, P=0.030; q=0.391, P=0.043). Conclusion In PH patients, the right ventricular function declined, and RT-3 DE can accurately evaluate the right ventricular function in patients with different degrees of pulmonary hypertension.
引文
1芮逸飞,颜紫宁,范莉,等.实时三维超声心动图评价肺动脉高压患者右心室收缩功能[J].中国医学影像学杂志,2012,20(5):372-375.
2 李一丹,吕秀章,王怡丹,等.经胸超声心动图评价肺动脉高压右心结构及功能的临床研究[J].中国超声医学杂志,2015,31(9):789-791.
3 邵柳华.实时三维超声心动图评价肺动脉高压患者右室整体和局部功能的初步研究[J].临床心血管病杂志,2010,26(12):898-901.
4 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,registered branch of the European Society of Cardiology,and the Canadian Society of Echocardiography[J].J Am Soc Echocardiogram,2010,23(7):685-713.
5 Aduen JF,Castello R,Lozano MM,et al.An alternative echocardiographic method to estimate mean pulmonary artery pressure:diagnostic and clinical implications[J].J Am Soc Echocardiogram,2009,22(7):814-819.
6 熊华强,曹铁生,罗向红,等.胸压对三尖瓣反流速度和肺动脉压测定的影响[J].中华超声影像学杂志,2009,18(4):284-287.
7 徐晶,谭羽莹,徐国良,等.超声心动图结合6MWT评价肺动脉高压患者右心功能[J].中国老年学杂志,2014,34(21):6183-6184.
8 Sanjay M,Mdcm FF,Doug H,et al.Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension:A clinical practice guideline[J].Can Respir J,2010,17(6):301-334.
9 Steven CP,Jens MP,Mehdi AF,et al.The role of inflammation in hypoxic pulmonary hypertension:from cellular mechanisms to clinical phenotypes[J].Am J Physiol Lung Cell Mol Physiol,2015,308(3):L229-L252.
10 王赟,杨军,白洋,等.斑点追踪技术及三维超声心动图评价肺动脉高压患者右心房功能[J].中国医学影像技术,2015,31(7):1019-1024.
11 周雪萍,陈翠兰,陈珂,等.超声心动图监测中老年女性肺动脉高压患者心功能的临床价值[J].中国老年学杂志,2015,35(13):3560-3561.
12 Hsu CH,Ho WJ,Huang WC,et al.2014 Guidelines of Taiwan Society of Cardiology(TSOC)for the Management of Pulmonary Arterial Hypertension[J].Acta Cardiol Sin,2014,30(5):401-444.
13 Nagel C,Henn P,Ehlken N,et al.Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonaryarterial hypertension[J].Arthritis Res Ther,2015,17(1):165-173.
14 Yu L,Hales CA.Hales hypoxia does neither stimulate pulmonary artery endothelial cell proliferation in mice and rats with pulmonary hypertension and vascular remodeling nor in human pulmonary artery endothelial cells[J].J Vasc Res,2011,48(6):465-475.
15 钱凤文,陈利明.超声心动图新技术在评价肺动脉高压患者右心功能中的应用进展[J].中国呼吸与危重监护杂志,2013,12(4):427-429.
16 王昕朋,安喆,魏君,等.超声心动图对先心病肺动脉高压(PAH)患者右心功能评价的意义[J].中国实验诊断学,2016,20(6):1019-1021.
17 Boueiz Adel,Hassoun PM.Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension:Pulmonary arterialhypertension associated with connective tissue diseases[J].Ann Thorac Med,2014,9 (Suppl 1):S26-S37.
18 Jujo T,Sakao S,Ishibashi-Ueda H,et al.Evaluation of the Microcirculation in Chronic Thromboembolic Pulmonary Hypertension Patients:The Impact of Pulmonary Arterial Remodeling on Postoperative and Follow-Up Pulmonary Arterial Pressure and Vascular Resistance[J].PLoS One,2015,10(8):e0133167.
19 李一丹,吴雅峰,马展鸿,等.超声心动图测量肺动脉高压患者血流动力学参数与右心导管测值的相关性[J].中国医学影像技术,2011,27(7):1405-1408.
20 高春恒,邹大中,高克明,等.实时三维超声心动图评价结缔组织病相关肺动脉高压患者左心室收缩功能及同步性[J].中华超声影像学杂志,2013,22(6):543-544.
21 Sithamparanathan S,Nair A,Thirugnanasothy L,et al.Survival in portopulmonary hypertension:Outcomes of the United Kingdom National Pulmonary Arterial Hypertension Registry[J].J Heart Lung Transplant,2017,36(7):770-779.
22 Bhatt SP,Dransfield MT,Cockcroft JR,et al.A randomized trial of once-daily fluticasone furoate/vilanterol or vilanterol versus placebo to determine effects on arterial stiffness in COPD[J].Int J Chron Obstruct Pulmon Dis,2017,12:351-365.
23 Tartavoulle TM.Management of Sepsis in Patients with Pulmonary Arterial Hypertension in the Intensive Care Unit[J].Crit Care Nurs Clin North Am,2017,29(1):15-23.
24 Lee SH,Kwon BS,Kim GB,et al.Prophylactic Pulmonary Artery Reduction in a Young Female with Severe PulmonaryHypertension from Complete Atrioventricular Septal Defect[J].Korean Circ J,2017,47(1):136-140.
25 Leberkühne LJ,Ploegstra MJ,Douwes JM,et al.Serially Measured Uric Acid Levels Predict Disease Severity and Outcome in Pediatric Pulmonary Arterial Hypertension[J].Am J Respir Crit Care Med,2017,195(3):401-404.
2 李一丹,吕秀章,王怡丹,等.经胸超声心动图评价肺动脉高压右心结构及功能的临床研究[J].中国超声医学杂志,2015,31(9):789-791.
3 邵柳华.实时三维超声心动图评价肺动脉高压患者右室整体和局部功能的初步研究[J].临床心血管病杂志,2010,26(12):898-901.
4 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,registered branch of the European Society of Cardiology,and the Canadian Society of Echocardiography[J].J Am Soc Echocardiogram,2010,23(7):685-713.
5 Aduen JF,Castello R,Lozano MM,et al.An alternative echocardiographic method to estimate mean pulmonary artery pressure:diagnostic and clinical implications[J].J Am Soc Echocardiogram,2009,22(7):814-819.
6 熊华强,曹铁生,罗向红,等.胸压对三尖瓣反流速度和肺动脉压测定的影响[J].中华超声影像学杂志,2009,18(4):284-287.
7 徐晶,谭羽莹,徐国良,等.超声心动图结合6MWT评价肺动脉高压患者右心功能[J].中国老年学杂志,2014,34(21):6183-6184.
8 Sanjay M,Mdcm FF,Doug H,et al.Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension:A clinical practice guideline[J].Can Respir J,2010,17(6):301-334.
9 Steven CP,Jens MP,Mehdi AF,et al.The role of inflammation in hypoxic pulmonary hypertension:from cellular mechanisms to clinical phenotypes[J].Am J Physiol Lung Cell Mol Physiol,2015,308(3):L229-L252.
10 王赟,杨军,白洋,等.斑点追踪技术及三维超声心动图评价肺动脉高压患者右心房功能[J].中国医学影像技术,2015,31(7):1019-1024.
11 周雪萍,陈翠兰,陈珂,等.超声心动图监测中老年女性肺动脉高压患者心功能的临床价值[J].中国老年学杂志,2015,35(13):3560-3561.
12 Hsu CH,Ho WJ,Huang WC,et al.2014 Guidelines of Taiwan Society of Cardiology(TSOC)for the Management of Pulmonary Arterial Hypertension[J].Acta Cardiol Sin,2014,30(5):401-444.
13 Nagel C,Henn P,Ehlken N,et al.Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonaryarterial hypertension[J].Arthritis Res Ther,2015,17(1):165-173.
14 Yu L,Hales CA.Hales hypoxia does neither stimulate pulmonary artery endothelial cell proliferation in mice and rats with pulmonary hypertension and vascular remodeling nor in human pulmonary artery endothelial cells[J].J Vasc Res,2011,48(6):465-475.
15 钱凤文,陈利明.超声心动图新技术在评价肺动脉高压患者右心功能中的应用进展[J].中国呼吸与危重监护杂志,2013,12(4):427-429.
16 王昕朋,安喆,魏君,等.超声心动图对先心病肺动脉高压(PAH)患者右心功能评价的意义[J].中国实验诊断学,2016,20(6):1019-1021.
17 Boueiz Adel,Hassoun PM.Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension:Pulmonary arterialhypertension associated with connective tissue diseases[J].Ann Thorac Med,2014,9 (Suppl 1):S26-S37.
18 Jujo T,Sakao S,Ishibashi-Ueda H,et al.Evaluation of the Microcirculation in Chronic Thromboembolic Pulmonary Hypertension Patients:The Impact of Pulmonary Arterial Remodeling on Postoperative and Follow-Up Pulmonary Arterial Pressure and Vascular Resistance[J].PLoS One,2015,10(8):e0133167.
19 李一丹,吴雅峰,马展鸿,等.超声心动图测量肺动脉高压患者血流动力学参数与右心导管测值的相关性[J].中国医学影像技术,2011,27(7):1405-1408.
20 高春恒,邹大中,高克明,等.实时三维超声心动图评价结缔组织病相关肺动脉高压患者左心室收缩功能及同步性[J].中华超声影像学杂志,2013,22(6):543-544.
21 Sithamparanathan S,Nair A,Thirugnanasothy L,et al.Survival in portopulmonary hypertension:Outcomes of the United Kingdom National Pulmonary Arterial Hypertension Registry[J].J Heart Lung Transplant,2017,36(7):770-779.
22 Bhatt SP,Dransfield MT,Cockcroft JR,et al.A randomized trial of once-daily fluticasone furoate/vilanterol or vilanterol versus placebo to determine effects on arterial stiffness in COPD[J].Int J Chron Obstruct Pulmon Dis,2017,12:351-365.
23 Tartavoulle TM.Management of Sepsis in Patients with Pulmonary Arterial Hypertension in the Intensive Care Unit[J].Crit Care Nurs Clin North Am,2017,29(1):15-23.
24 Lee SH,Kwon BS,Kim GB,et al.Prophylactic Pulmonary Artery Reduction in a Young Female with Severe PulmonaryHypertension from Complete Atrioventricular Septal Defect[J].Korean Circ J,2017,47(1):136-140.
25 Leberkühne LJ,Ploegstra MJ,Douwes JM,et al.Serially Measured Uric Acid Levels Predict Disease Severity and Outcome in Pediatric Pulmonary Arterial Hypertension[J].Am J Respir Crit Care Med,2017,195(3):401-404.