超声心动图监测兔急性肺栓塞模型右心室功能与栓子大小的相关性
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摘要
目的采用超声心动图监测兔急性肺栓塞模型右心室功能与栓子大小的相关性。材料与方法健康新西兰兔33只,采用随机数字表法分为大栓子组、小栓子组和对照组,每组11只。采用自体血制备大小分别为1 mm×1 mm×6 mm(小栓子)、2 mm×2 mm×6 mm(大栓子)的圆柱形血栓。大栓子组、小栓子组经颈静脉快速注入10 ml自体血栓(4条)与生理盐水的混合液,制备急性肺栓塞模型;对照组注入10 ml生理盐水。采用超声心动图监测栓塞后1 h右心室形态及功能改变,测量计算右心室舒张末期横径(RVTD)、左心室舒张末期横径(LVTD)、舒张末期右心室与左心室横径比值(RV/LV)、右心室舒张末期面积(RVAd)、收缩末期面积(RVAs)、右心室面积变化率(RVFAC)三尖瓣环收缩期位移(TAPSE)、右心室心肌做功指数(Tei指数)、等容收缩加速度(IVA)。留取肺组织标本行HE染色,观察肺栓塞兔肺部病理改变。比较不同组间超声指标的差异,并采用受试者工作特性(ROC)曲线评价诊断效能。结果实验组22只兔中,造模成功18只,其中小栓子组10只,大栓子组8只。与对照组比较,肺栓塞组兔右心室扩大,右心功能降低。小栓子组RVFAC和IVA较对照组降低,差异有统计学意义(P<0.05),但RVTD、RV/LV比值、TAPSE及Tei指数与对照组比较,差异无统计学意义(P>0.05);大栓子组右心室明显增大,右心室功能显著降低,与对照组比较,差异均有统计学意义(P<0.05);大栓子组与小栓子组比较,RVTD、RVFAC、RV/LV比值、Tei指数、IVA差异均有统计学意义(P<0.05),但TAPSE与小栓子组比较,差异无统计学意义(P>0.05)。IVA评价急性肺栓塞右心室功能改变的敏感度(94.4%)及特异度(81.8%)均较高。病理结果显示,肺栓塞组兔肺动脉内见圆柱形血栓,并见红细胞渗出。结论栓子大小是影响肺栓塞右心室功能改变的重要因素。超声心动图对于肺栓塞右心室形态及功能的评估具有重要意义。IVA能敏感地反映右心室功能改变。
Purpose To determine the correlation between the size of thrombus and right ventricular function using echocardiography in rabbits with acute pulmonary embolism(PE). Materials and Methods Thirty-three healthy New Zealand rabbits were randomly divided(by using a random number table) into massive thrombus group, sub-massive thrombus group and control group, 11 rabbits each. Autologous blood was used to prepare cylindrical thrombus with a size of 1 mm×1 mm×6 mm(small embolus) and 2 mm×2 mm×6 mm(large embolus) respectively. Animal models of acute pulmonary embolism were created by injecting a 10 ml mixture of autologous blood clots(n=4) and normal saline via jugular vein catheterization, and another 11 rabbits received injection with 10 ml saline to serve as the control group. Right ventricular function in all rabbits was evaluated using echocardiography at 1 hour after embolization. Echocardiographic indices, including right ventricular transverse diameter(RVTD), left ventricular transverse diameter(LVTD), right/left ventricular end-diastolic diameter ratio(RV/LV), right ventricular end-diastolic area(RVAd), right ventricular end-systolic area(RVAs), right ventricular fractional area change(RVFAC), tricuspid annular plane systolic excursion(TAPSE), right ventricular index of myocardial performance(Tei index) and isovolumic acceleration(IVA), were measured and calculated. Specimens from lung tissue were gathered and stained with HE. Pathological changes of lung tissue in acute PE were observed through an optical microscope. The difference of ultrasound indexes among different groups were compared, and the receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficiency. Results Among the 22 experimental rabbits, the acute pulmonary embolism model was successfully established in 18 rabbits, including 10 in sub-massive thrombus group and 8 in massive thrombus group. Compared with control group, Rabbits in acute pulmonary embolism group had different degrees of RV dilation and systolic dysfunction. Compared with the control group, the value of RVFAC and IVA in sub-massive thrombus group were significantly decreased(P<0.05), but there was no significant difference in RVTD, RV/LV, TAPSE and Tei index between control group and sub-massive thrombus group(P>0.05). Massive thrombus group resulted in a significant reduction in RV function, and a significant increase in RV dimension, with statistically significant differences(P<0.01). The results of RVTD, RVFAC, RV/LV, Tei index and IVA showed significant differences between sub-massive thrombus group and massive thrombus group(P<0.01). However, massive thrombus group suggested a slightly decreased TAPSE, with no significant difference compared with massive thrombus group(P>0.05). ROC showed that IVA had a high sensitivity(94.4%) and specificity(81.8%) in the assessment of RV function in acute PE. Pathologic results showed that the pulmonary vessels were obstructed by masses of the massive or sub-massive thrombi and erythrocyte effusion were observed simultaneously. Conclusion The size of thrombus is a crucial factor which affects the right ventricular function in acute pulmonary embolism. Echocardiography plays an important role in the evaluation of the right ventricular shape and function in acute pulmonary embolism. IVA can sensitively reflect the changes of RV function.
Purpose To determine the correlation between the size of thrombus and right ventricular function using echocardiography in rabbits with acute pulmonary embolism(PE). Materials and Methods Thirty-three healthy New Zealand rabbits were randomly divided(by using a random number table) into massive thrombus group, sub-massive thrombus group and control group, 11 rabbits each. Autologous blood was used to prepare cylindrical thrombus with a size of 1 mm×1 mm×6 mm(small embolus) and 2 mm×2 mm×6 mm(large embolus) respectively. Animal models of acute pulmonary embolism were created by injecting a 10 ml mixture of autologous blood clots(n=4) and normal saline via jugular vein catheterization, and another 11 rabbits received injection with 10 ml saline to serve as the control group. Right ventricular function in all rabbits was evaluated using echocardiography at 1 hour after embolization. Echocardiographic indices, including right ventricular transverse diameter(RVTD), left ventricular transverse diameter(LVTD), right/left ventricular end-diastolic diameter ratio(RV/LV), right ventricular end-diastolic area(RVAd), right ventricular end-systolic area(RVAs), right ventricular fractional area change(RVFAC), tricuspid annular plane systolic excursion(TAPSE), right ventricular index of myocardial performance(Tei index) and isovolumic acceleration(IVA), were measured and calculated. Specimens from lung tissue were gathered and stained with HE. Pathological changes of lung tissue in acute PE were observed through an optical microscope. The difference of ultrasound indexes among different groups were compared, and the receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficiency. Results Among the 22 experimental rabbits, the acute pulmonary embolism model was successfully established in 18 rabbits, including 10 in sub-massive thrombus group and 8 in massive thrombus group. Compared with control group, Rabbits in acute pulmonary embolism group had different degrees of RV dilation and systolic dysfunction. Compared with the control group, the value of RVFAC and IVA in sub-massive thrombus group were significantly decreased(P<0.05), but there was no significant difference in RVTD, RV/LV, TAPSE and Tei index between control group and sub-massive thrombus group(P>0.05). Massive thrombus group resulted in a significant reduction in RV function, and a significant increase in RV dimension, with statistically significant differences(P<0.01). The results of RVTD, RVFAC, RV/LV, Tei index and IVA showed significant differences between sub-massive thrombus group and massive thrombus group(P<0.01). However, massive thrombus group suggested a slightly decreased TAPSE, with no significant difference compared with massive thrombus group(P>0.05). ROC showed that IVA had a high sensitivity(94.4%) and specificity(81.8%) in the assessment of RV function in acute PE. Pathologic results showed that the pulmonary vessels were obstructed by masses of the massive or sub-massive thrombi and erythrocyte effusion were observed simultaneously. Conclusion The size of thrombus is a crucial factor which affects the right ventricular function in acute pulmonary embolism. Echocardiography plays an important role in the evaluation of the right ventricular shape and function in acute pulmonary embolism. IVA can sensitively reflect the changes of RV function.
引文
[1]Konstantinides SV,Torbicki A,Agnelli G,et al.Corrigendum to:2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.Eur Heart J,2015,36(39):2642.
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[3]吴文振,郝恩魁,程义伟,等.不同急性肺动脉高压模型的建立及其血流动力学转归的实验研究.山东大学学报(医学版),2012,50(3):34-39.
[4]吴颂红,徐英进,宋利宏,等.家兔急性肺血栓栓塞模型的制备及其影像学表现.医学影像学杂志,2007,17(5):462-464.
[5]Sanchez O,Trinquart L,Colombet I,et al.Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism:a systematic review.Eur Heart J,2008,29(12):1569-1577.
[6]黄建,吴刚.多层螺旋CT肺动脉成像右心室参数评估急性肺栓塞的临床研究.中国医学影像学杂志,2017,25(4):270-273.
[7]Ten Wolde M,S?hne M,Quak E,et al.Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism.Arch Intern Med,2004,164(15):1685-1689.
[8]潘永寿,郭盛兰,刘唐威,等.经胸超声心动图诊断急性肺动脉栓塞的价值.中国超声医学杂志,2005,21(3):195-197.
[9]Frémont B,Pacouret G,Jacobi D,et al.Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism:results from a monocenter registry of 1,416 patients.Chest,2008,133(2):358-362.
[10]王玥,崔文姬.实时三维超声心动图对右心室功能评价的应用进展.中国医学影像学杂志,2015,23(10):794-796.
[11]Paczyńska M,Sobieraj P,Burzyński?,et al.Tricuspid annulus plane systolic excursion(TAPSE)has superior predictive value compared to right ventricular to left ventricular ratio in normotensive patients with acute pulmonary embolism.Arch Med Sci,2016,12(5):1008-1014.
[12]Mcconnell MV,Solomon SD,Rayan ME,et al.Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism.Am J Cardiol,1996,78(4):469-473.
[13]Casazza F,Bongarzoni A,Capozi A,et al.Regional right ventricular dysfunction in acute pulmonary embolism and right ventricular infarction.Eur J Echocardiogr,2005,6(1):11-14.
[14]Kj?rgaard J.Assessment of right ventricular systolic function by tissue Doppler echocardiography.Dan Med J,2012,59(3):B4409.
[15]王静,张健,范小明,等.组织多普勒右心室Tei指数评价肺动脉高压模型兔右心室功能的实验研究.医学影像学杂志,2014,24(7):1243-1246.
[16]Vogel M,Schmidt MR,Kristiansen SB,et al.Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility:comparison with ventricular pressure-volume relations in an animal model.Circulation,2002,105(14):1693-1699.
[2]Jaff MR,Mcmurtry MS,Archer SL,et al.Management of massive and submassive pulmonary embolism,iliofemoral deep vein thrombosis,and chronic thromboembolic pulmonary hypertension:a scientific statement from the american heart association.Circulation,2011,123(16):1788-1830.
[3]吴文振,郝恩魁,程义伟,等.不同急性肺动脉高压模型的建立及其血流动力学转归的实验研究.山东大学学报(医学版),2012,50(3):34-39.
[4]吴颂红,徐英进,宋利宏,等.家兔急性肺血栓栓塞模型的制备及其影像学表现.医学影像学杂志,2007,17(5):462-464.
[5]Sanchez O,Trinquart L,Colombet I,et al.Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism:a systematic review.Eur Heart J,2008,29(12):1569-1577.
[6]黄建,吴刚.多层螺旋CT肺动脉成像右心室参数评估急性肺栓塞的临床研究.中国医学影像学杂志,2017,25(4):270-273.
[7]Ten Wolde M,S?hne M,Quak E,et al.Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism.Arch Intern Med,2004,164(15):1685-1689.
[8]潘永寿,郭盛兰,刘唐威,等.经胸超声心动图诊断急性肺动脉栓塞的价值.中国超声医学杂志,2005,21(3):195-197.
[9]Frémont B,Pacouret G,Jacobi D,et al.Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism:results from a monocenter registry of 1,416 patients.Chest,2008,133(2):358-362.
[10]王玥,崔文姬.实时三维超声心动图对右心室功能评价的应用进展.中国医学影像学杂志,2015,23(10):794-796.
[11]Paczyńska M,Sobieraj P,Burzyński?,et al.Tricuspid annulus plane systolic excursion(TAPSE)has superior predictive value compared to right ventricular to left ventricular ratio in normotensive patients with acute pulmonary embolism.Arch Med Sci,2016,12(5):1008-1014.
[12]Mcconnell MV,Solomon SD,Rayan ME,et al.Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism.Am J Cardiol,1996,78(4):469-473.
[13]Casazza F,Bongarzoni A,Capozi A,et al.Regional right ventricular dysfunction in acute pulmonary embolism and right ventricular infarction.Eur J Echocardiogr,2005,6(1):11-14.
[14]Kj?rgaard J.Assessment of right ventricular systolic function by tissue Doppler echocardiography.Dan Med J,2012,59(3):B4409.
[15]王静,张健,范小明,等.组织多普勒右心室Tei指数评价肺动脉高压模型兔右心室功能的实验研究.医学影像学杂志,2014,24(7):1243-1246.
[16]Vogel M,Schmidt MR,Kristiansen SB,et al.Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility:comparison with ventricular pressure-volume relations in an animal model.Circulation,2002,105(14):1693-1699.