二维斑点追踪技术评价心力衰竭患者右心室功能
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摘要
目的采用二维斑点追踪成像(2D-STI)评估心力衰竭(HF)患者右心室(RV)功能。方法对31例射血分数下降型HF患者(HFREF组)、41例射血分数保留型HF患者(HFPEF组)及26名健康志愿者(对照组)行彩色多普勒超声检查,于心尖四腔心切面图像获得常规超声参数:RV壁厚度、RV基底段内径(RVD1)、RV收缩末期面积(RVESA)、RV舒张末期面积(RVEDA)、面积变化分数(RVFAC)、三尖瓣环收缩峰值速度(S')、心肌做功指数(MPI)、三尖瓣环收缩期位移(TAPSE)及左心室射血分数(LVEF);应用2D-STI技术获得RV游离壁基底段应变(RVLSbas)、中间段应变(RVLSmid)、心尖段应变(RVLSapi)及整体应变(RVLSfw)。比较3组间二维应变参数,分析RVLSfw与常规超声参数的相关性。结果 3组间RV壁厚度、RVD1、MPI、RVFAC、TAPSE及LVEF差异均有统计学意义(P均<0.01)。对照组、HFPEF组及HFREF组间RVLSbas、RVLSmid、RVLSfw均逐渐降低(P均<0.05)。HF患者RVLSfw与LVEF、TAPSE、MPI及RV壁厚度均呈强相关(r=-0.68、-0.53、0.52、0.51,P均<0.01),与RVD1、FAC、S'均呈弱相关(r=0.42、-0.46、-0.39,P均<0.01)。结论二维应变参数可用于评估HF患者RV功能。
Objective To evaluate the right ventricular(RV)function with 2Dspeckle tracking imaging(2D-STI)in patients with heart failure(HF).Methods Echocardiography was performed in 31 HF patients with reduced ejection fraction(HFREF group),41 HF patients with preserved ejection fraction(HFPEF group)and 26 healthy volunteers(control group).Conventional ultrasonic parameters were obtained on apical four-chamber images,including RV wall thickness,RV basal diameter(RVD1),RV end systolic area(RVESA),RV end diastolic area(RVEDA),RV fractional area change(RVFAC),peak systolic velocity(S'),myocardial performance index(MPI),tricuspid annular plane systolic excursion(TAPSE)and left ventricular ejection fraction(LVEF).2D-STI was performed to observe strain parameters,including basal,middle,apical and the whole longitudinal peak systolic strain of RV free wall respectively(RVLSbas,RVLSmid,RVLSapi and RVLSfw).Then 2D strain parameters were compared among the three groups,and the correlation of 2Dstrain parameters and conventional ultrasonic parameters were analyzed.Results RV wall thickness,RVD1,MPI,RVFAC,TAPSE and LVEF were all significantly different among three groups(all P<0.01).RVLSbas,RVLSmid and RVLSfw gradually reduced in control group,HFPEF group and HFREF group(all P<0.05).RVLSfw had strong correlation with LVEF,TAPSE,MPI and RV wall thickness(r=-0.68,-0.53,0.52,0.51,all P<0.01)and had weak correlation with RVD1,FAC and S'(r=0.42,-0.46,-0.39,all P<0.01).Conclusion 2Dstrain parameters can be used to assess RV function in patients with HF.
Objective To evaluate the right ventricular(RV)function with 2Dspeckle tracking imaging(2D-STI)in patients with heart failure(HF).Methods Echocardiography was performed in 31 HF patients with reduced ejection fraction(HFREF group),41 HF patients with preserved ejection fraction(HFPEF group)and 26 healthy volunteers(control group).Conventional ultrasonic parameters were obtained on apical four-chamber images,including RV wall thickness,RV basal diameter(RVD1),RV end systolic area(RVESA),RV end diastolic area(RVEDA),RV fractional area change(RVFAC),peak systolic velocity(S'),myocardial performance index(MPI),tricuspid annular plane systolic excursion(TAPSE)and left ventricular ejection fraction(LVEF).2D-STI was performed to observe strain parameters,including basal,middle,apical and the whole longitudinal peak systolic strain of RV free wall respectively(RVLSbas,RVLSmid,RVLSapi and RVLSfw).Then 2D strain parameters were compared among the three groups,and the correlation of 2Dstrain parameters and conventional ultrasonic parameters were analyzed.Results RV wall thickness,RVD1,MPI,RVFAC,TAPSE and LVEF were all significantly different among three groups(all P<0.01).RVLSbas,RVLSmid and RVLSfw gradually reduced in control group,HFPEF group and HFREF group(all P<0.05).RVLSfw had strong correlation with LVEF,TAPSE,MPI and RV wall thickness(r=-0.68,-0.53,0.52,0.51,all P<0.01)and had weak correlation with RVD1,FAC and S'(r=0.42,-0.46,-0.39,all P<0.01).Conclusion 2Dstrain parameters can be used to assess RV function in patients with HF.
引文
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[7] Carlsson M,Ugander M,Heiberg E,et al.The quantitative relationship betweenlongitudinal and radial function in left,right,and total heart pumping in humans.Am J Physiol Heart Circ Physiol,2007,293(1):H636-H644.
[8] Setaro JF,Cleman MW,Remetz MS.The right ventricle in disorders causing pulmonary venous hypertension.Cardiol Clin,1992,10(1):165-183.
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[10] Broberg CS,Chugh SS,Conklin C,et al.Quantification of diffuse myocardial fibrosis and its association with myocardial dysfunction in congenital heart disease. Circ Cardiovasc Imaging,2010,3(6):727-734.
[11] Zornoff LA,Skali H, Pfeffer MA,et al.Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction.J Am Coll Cardiol,2002,39(9):1450-1455.
[12] Meris A,Faletra F,Conca C,et al.Timing and magnitude of regional right ventricular function:A speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction.J Am Soc Echocardiogr,2010,23(8):823-831.
[2] Ghio S,Gavazzi A,Campana C,et al.Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure.J Am Coll Cardiol,2001,37(1):183-188.
[3] Apostolakis S,Konstantinides S.The right ventricle in health and disease:Insights into physiology, pathophysiology and diagnostic management.Cardiology,2012,121(4):263-273.
[4] Ponikowski P,Voors AA,Anker SD,et al.2016ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.Rev Esp Cardiol(Engl Ed),2016,69(12):1167.
[5] Wang J,Khoury DS,Yue Y,et al.Preserved left ventricular twist and circumferential deformation,but depressed longitudinal and radial deformation in patients with diastolic heart failure.Eur Heart J,2008,29(10):1283-1289.
[6] Park JH, Negishi K, Kwon DH,et al. Validation of global longitudinal strain and strain rate as reliable markers of right ventricular dysfunction:Comparison with cardiac magnetic resonance and outcome.J Cardiovasc Ultrasound,2014,22(3):113-120.
[7] Carlsson M,Ugander M,Heiberg E,et al.The quantitative relationship betweenlongitudinal and radial function in left,right,and total heart pumping in humans.Am J Physiol Heart Circ Physiol,2007,293(1):H636-H644.
[8] Setaro JF,Cleman MW,Remetz MS.The right ventricle in disorders causing pulmonary venous hypertension.Cardiol Clin,1992,10(1):165-183.
[9] Bogaard HJ, Natarajan R, Henderson SC,et al. Chronic pulmonary artery pressure elevation is insufficient to explain right heart failure.Circulation,2009,120(20):1951-1960.
[10] Broberg CS,Chugh SS,Conklin C,et al.Quantification of diffuse myocardial fibrosis and its association with myocardial dysfunction in congenital heart disease. Circ Cardiovasc Imaging,2010,3(6):727-734.
[11] Zornoff LA,Skali H, Pfeffer MA,et al.Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction.J Am Coll Cardiol,2002,39(9):1450-1455.
[12] Meris A,Faletra F,Conca C,et al.Timing and magnitude of regional right ventricular function:A speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction.J Am Soc Echocardiogr,2010,23(8):823-831.