二维斑点追踪技术在尿毒症患者右心室收缩功能评价中的应用价值
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摘要
目的探讨超声二维斑点追踪技术(2D-STI)在尿毒症患者的右心功能评价中的应用价值。方法健康对照组20例,尿毒症患者(尿毒症组)20例,采用双平面Simpson法获得尿毒症患者右室舒张期末容积(RVEDV)、右室收缩期末容积(RVESV)、右室每搏量(RVSV)、右室每分输出量(RVCO)及右室射血分数(RVEF)。应用2D-STI技术获得两组右室两腔及四腔切面三尖瓣瓣环相对心尖的纵向位移曲线,得出对应的最大纵向位移及其占心尖到瓣环中点处最大化峰值位移的百分比(Dm%)进行比较分析;应用最小二乘法分别对RVEF与四腔心、两腔心切面瓣环连线中点处的收缩期峰值位移(FTADmid、TTADmid),以及其占Dm的百分比(FTADmid%、TTADmid%)做线性回归分析。结果①尿毒症组患者RVEDV、RVESV、RVSV及RVCO高于对照组(P <0.05);②尿毒症组患者RVEF低于对照组(P <0.05);③尿毒症组患者四腔心和两腔心切面三尖瓣环右室游离壁收缩期峰值位移(TADfre)、间隔处收缩期峰值位移(TADsep)、FTADmid及FTADmid%低于对照组(P <0.05),两腔心切面的前壁收缩期峰值位移(TADant)、后壁收缩期峰值位移(TADpos)、TTADmid及TTADmid%低于对照组(P<0.05);④尿毒症组RVEF与FTADmid、FTADmid%、TTADmid及TTADmid%相关系数分别为0.910、0.922、0.844和0.841,(P <0.05);对照组RVEF与FTADmid、FTADmid%、TTADmid及TTADmid%相关系数分别为0.834、0.842、0.783和0.772,(P <0.05)。结论 2D-STI可作为尿毒症患者右心收缩功能评价的有效手段。
Objective To discuss application of ultrasound two-dimensional speckle tracking in the evaluation of right heart function in patients with uremia. Methods There were 20 healthy controls and 20 uremic patients.Right ventricular end-diastolic volume(RVEDV), right ventricular end-systolic volume(RVESV), right ventricular stroke volume(RVSV), right ventricular output per minute(RVCO) and right ventricular ejection fraction(RVEF)in uremic patients were obtained by biplane Simpson method. Longitudinal displacement curves of tricuspid annulus relative to apex in two and four-chamber sections of right ventricle were obtained by 2 D-STI technique. The corresponding maximum longitudinal displacement and its percentage of maximum peak displacement(Dm%) from the apex to the midpoint of the annulus were obtained and compared. The correlation between RVEF and peak systolic displacement(FTADmid, TTADmid) at the midpoint of four-chamber and two-chamber cardiac tangential annulus and its percentage of Dm(FTADmid, TTADmid%) was analyzed by linear regression method. Results ① The RVEDV, RVESV, RVSV and RVCO of uremic patients were higher than those of the control group(P < 0.05). ② The RVEF of uremic group was lower than that of the control group(P < 0.05) ③ The peak systolic value(TADfre), the peak systolic value(TADsep), the peak systolic value(FTADmid) at the midpoint of the annulus commissurae and the percentage of FTADmid% to Ds were all lower in the uremic group than those in the control group(P < 0.05);The peak systolic time(TADant), the peak systolic time(TADpos), the peak systolic time(TTADmid) at the midpoint of the annular junction and the percentage of TTADmid% to Ds in the uremic group were lower than those in the control group(P < 0.05). ④ The correlation coefficients between RVEF and FTADmid, FTADmid, TTADmid and TTADmid% were 0.920, 0.922, 0.844 and 0.841 in uremia and 0.837, 0.842, 0.783 and 0.772 in control group(all P < 0.05). Conclusions Two-dimensional speckle tracking imaging can be used as an effective method for evaluating right ventricular systolic function in uremic patients.
Objective To discuss application of ultrasound two-dimensional speckle tracking in the evaluation of right heart function in patients with uremia. Methods There were 20 healthy controls and 20 uremic patients.Right ventricular end-diastolic volume(RVEDV), right ventricular end-systolic volume(RVESV), right ventricular stroke volume(RVSV), right ventricular output per minute(RVCO) and right ventricular ejection fraction(RVEF)in uremic patients were obtained by biplane Simpson method. Longitudinal displacement curves of tricuspid annulus relative to apex in two and four-chamber sections of right ventricle were obtained by 2 D-STI technique. The corresponding maximum longitudinal displacement and its percentage of maximum peak displacement(Dm%) from the apex to the midpoint of the annulus were obtained and compared. The correlation between RVEF and peak systolic displacement(FTADmid, TTADmid) at the midpoint of four-chamber and two-chamber cardiac tangential annulus and its percentage of Dm(FTADmid, TTADmid%) was analyzed by linear regression method. Results ① The RVEDV, RVESV, RVSV and RVCO of uremic patients were higher than those of the control group(P < 0.05). ② The RVEF of uremic group was lower than that of the control group(P < 0.05) ③ The peak systolic value(TADfre), the peak systolic value(TADsep), the peak systolic value(FTADmid) at the midpoint of the annulus commissurae and the percentage of FTADmid% to Ds were all lower in the uremic group than those in the control group(P < 0.05);The peak systolic time(TADant), the peak systolic time(TADpos), the peak systolic time(TTADmid) at the midpoint of the annular junction and the percentage of TTADmid% to Ds in the uremic group were lower than those in the control group(P < 0.05). ④ The correlation coefficients between RVEF and FTADmid, FTADmid, TTADmid and TTADmid% were 0.920, 0.922, 0.844 and 0.841 in uremia and 0.837, 0.842, 0.783 and 0.772 in control group(all P < 0.05). Conclusions Two-dimensional speckle tracking imaging can be used as an effective method for evaluating right ventricular systolic function in uremic patients.
引文
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[7]叶振盛,戴莹,欧宓,等.超声二维应变评价慢性心力衰竭患者右室心肌纵向收缩功能[J].临床心血管病杂志, 2014, 30(9):797-799.
[8]孙品,杨武,肖丽,等.速度向量成像技术和QLAB定量软件评价阻塞性睡眠呼吸暂停综合征患者右室功能的临床研究[J].临床超声医学杂志, 2017, 19(3):174-177.
[9]LAWRENCE G R, WYMAN W L, JONATHAN A, et a1.Guidelinesfortheechocardiographicassessmentofthe right heart in adults:a report from the American society of echocardiography[J]. J Am Soc Echocardiography, 2010, 23:685-713.
[10]刘洪,郑东,彭洪,等.超声二维斑点追踪显像在缩窄性心包炎左室纵向运动定量评价中的应用[J].重庆医学, 2015(15):2116-2117, 2118.
[11]TAMBORINI G, PEPI M, GALLI C A, et al. Feasibility and accuracyofaroutineechocardiographicassessmentofright ventricular function[J]. Int J Cardiol, 2007, 115(1):86-89.
[12]董金杭,陈明.三维斑点追踪成像技术测定左心室功能的临床应用现状[J].重庆医学, 2014, 11:1388-1391.
[2]魏虹.二维斑点追踪技术评价持续性血液透析患者单次透析前后左心室收缩功能变化[D].沈阳:中国医科大学, 2014.
[3]VAHANIAN A, OTTAVIOET A, FELICITA A. Guidelines on the management of valvular heart disease(version 2012)[J]. Eur Heart J, 2012, 33(19):2451-2496.
[4]卜德华,黄文凡.超声斑点追踪组织瓣环位移技术及右心室面积变化率定量评价肺动脉高压患者右室收缩功能[J].医学影像学杂志, 2016, 26(7):1212-1216.
[5]刘婷婷,李金国.二维及实时三维超声心动图评价右心室容积的准确度研究[J].中国超声医学杂志, 2014, 30(11):1000-1003.
[6]TORRENT-GUASP F, BUCKBERG G D, CLEMENTE C, et al. The structure and function of the helical heart and its buttress wrapping.I. Thenormalmacroscopicstructureoftheheart[J].Semin Thorac Cardiovasc Surg, 2001, 13(4):301-319.
[7]叶振盛,戴莹,欧宓,等.超声二维应变评价慢性心力衰竭患者右室心肌纵向收缩功能[J].临床心血管病杂志, 2014, 30(9):797-799.
[8]孙品,杨武,肖丽,等.速度向量成像技术和QLAB定量软件评价阻塞性睡眠呼吸暂停综合征患者右室功能的临床研究[J].临床超声医学杂志, 2017, 19(3):174-177.
[9]LAWRENCE G R, WYMAN W L, JONATHAN A, et a1.Guidelinesfortheechocardiographicassessmentofthe right heart in adults:a report from the American society of echocardiography[J]. J Am Soc Echocardiography, 2010, 23:685-713.
[10]刘洪,郑东,彭洪,等.超声二维斑点追踪显像在缩窄性心包炎左室纵向运动定量评价中的应用[J].重庆医学, 2015(15):2116-2117, 2118.
[11]TAMBORINI G, PEPI M, GALLI C A, et al. Feasibility and accuracyofaroutineechocardiographicassessmentofright ventricular function[J]. Int J Cardiol, 2007, 115(1):86-89.
[12]董金杭,陈明.三维斑点追踪成像技术测定左心室功能的临床应用现状[J].重庆医学, 2014, 11:1388-1391.