实时三维超声及组织速度向量评价肺动脉高压患者右心室收缩功能及相关性研究
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摘要
目的应用实时三维超声(RT-3DE)及组织速度向量(VVI)技术评价右心室整体及局部收缩功能,预测其在肺动脉高压(PH)患者右心功能衰竭中的价值。方法选取我院诊断的PH患者86例,根据肺动脉收缩压(PASP)分为轻中度组、重度组,每组43例,选择体检健康人35例作为对照组,应用实时三维超声定量分析右心室三维射血分数(3D-RVEF),右心室三维每搏量(3D-RVSV),右心室三维舒张末容积(3D-RVEDV),右心室三维收缩末容积(3D-RVESV),采用VVI技术分析右心室六个节段心肌纵向应变(L-S)、应变率(L-SR)、整体应变(Globle S)及应变率(Globle SR),并分析各参数之间的关系。结果与对照组比较,轻中度组和重度组3D-RVEF逐渐减低,3DRVEDV、3D-RVESV及3D-RVSV增高(P<0.01);3组右心室室间隔心尖段的L-SR比较差异无统计学意义(P>0.05),与对照组比较,两PH组右心室其余各节段L-S,L-SR均减低(P<0.05),与轻中度组比较,重度组右心室L-S及L-SR降低更明显(P<0.05),与对照组比较,两PH组右心室其余各节段L-S,L-SR、Globle S及Globle SR均减低(P<0.05),与轻中度组比较,重度组降低更明显(P<0.05),3D-RVEF与Globle S,Globle SR呈正相关。PASP与Globle S,Globle SR呈负相关,但相关性均不强。结论肺动脉高压组右心室整体收缩功能有所降低,随着肺动脉压力逐渐增高,右心室各节段纵向应变及应变率逐渐减低,但是在不同程度PH组中,右心室局部收缩功能变化比整体功能变化更早。
Objective To evaluate the global and regional systolic function of the right ventricle using realtime three-dimensional ultrasound(RT-3 DE)and tissue velocity vector image(VVI)techniques,and to predict its value to patients with pulmonary hypertension(PH)associated with right heart failure.Methods A total of 86 PH patients was selected and divided into two groups according to pulmonary arterial systolic pressure(PASP):the light-tomoderate PH group mild group and the severe PH group.Totally 43 patients in each group were selected for physical examination.Realtime three-dimensional ultrasound quantitative analysis of right ventricular three-dimensional ejection fraction(3 D-RVEF),right ventricular three-dimensional stroke volume(3 D-RVSV),right ventricular threedimensional enddiastolic volume(3 D-RVEDV),right ventricular three-dimensional endsystolic volume(3 D-RVESV)were analyzed using the VVI technique to analyze the longitudinal myocardial strain(LS),strain rate(L-SR)global strain(Globle S)and strain rate(Globle SR)in six segments of the right ventricle.The relationship between the parameters was analysed.Results Compared with the control group,3 DRVEF was gradually decreased in the mild-tomoderate group and the severe group,and 3 D-RVEDV,3 D-RVESV,and 3 D-RVSV witnessed increase(P <0.01).There was no statistical difference in LSR between the three groups of interventricular septum A.Compared with the control group,the LS and LSR in the left ventricular segments of the right ventricle in both PH groups decreased(P <0.05).Compared with the light-to-moderate group,the LS and LSR in the severe group decreased.Compared with the control group,the LS and LSR in the left ventricular segments of the right ventricle in both PH groups decreased(P <0.05).Compared with the light-to-moderate group,the LS and LSR in the severe group decreased.3 DRVEF was positively correlated with Globe S and Globle SR.PASP was negatively correlated with Globle S and Globle SR,but the correlation was not strong.Conclusion The systolic function of the right ventricle in the pulmonary arterial hypertension group was reduced.With the increase of the pulmonary artery pressure,the longitudinal strain and strain rate of the right ventricle segments gradually decreased.However,in the groups with different levels of PH,the change of right ventricular local systolic function was earlier that of the overall function.
Objective To evaluate the global and regional systolic function of the right ventricle using realtime three-dimensional ultrasound(RT-3 DE)and tissue velocity vector image(VVI)techniques,and to predict its value to patients with pulmonary hypertension(PH)associated with right heart failure.Methods A total of 86 PH patients was selected and divided into two groups according to pulmonary arterial systolic pressure(PASP):the light-tomoderate PH group mild group and the severe PH group.Totally 43 patients in each group were selected for physical examination.Realtime three-dimensional ultrasound quantitative analysis of right ventricular three-dimensional ejection fraction(3 D-RVEF),right ventricular three-dimensional stroke volume(3 D-RVSV),right ventricular threedimensional enddiastolic volume(3 D-RVEDV),right ventricular three-dimensional endsystolic volume(3 D-RVESV)were analyzed using the VVI technique to analyze the longitudinal myocardial strain(LS),strain rate(L-SR)global strain(Globle S)and strain rate(Globle SR)in six segments of the right ventricle.The relationship between the parameters was analysed.Results Compared with the control group,3 DRVEF was gradually decreased in the mild-tomoderate group and the severe group,and 3 D-RVEDV,3 D-RVESV,and 3 D-RVSV witnessed increase(P <0.01).There was no statistical difference in LSR between the three groups of interventricular septum A.Compared with the control group,the LS and LSR in the left ventricular segments of the right ventricle in both PH groups decreased(P <0.05).Compared with the light-to-moderate group,the LS and LSR in the severe group decreased.Compared with the control group,the LS and LSR in the left ventricular segments of the right ventricle in both PH groups decreased(P <0.05).Compared with the light-to-moderate group,the LS and LSR in the severe group decreased.3 DRVEF was positively correlated with Globe S and Globle SR.PASP was negatively correlated with Globle S and Globle SR,but the correlation was not strong.Conclusion The systolic function of the right ventricle in the pulmonary arterial hypertension group was reduced.With the increase of the pulmonary artery pressure,the longitudinal strain and strain rate of the right ventricle segments gradually decreased.However,in the groups with different levels of PH,the change of right ventricular local systolic function was earlier that of the overall function.
引文
[1]Lvy DD,Abman SH,Barst RJ,et al.Pediatric pulmonary hypertension[J].J Am Coll Cardiol,2013,62(25Suppl):D117-126.
[2]Abman SH,Hansmann G,Archer SL,et al.Pediatric pulmonary hypertension:guidelines from the American Heart Association and American Thoracic Society[J].Circulation,2015,132(21):2037-2099.
[3]Vallerie V,McLaughlin MD,FACC,et al.ACCF/AHA 2009expert conserlsus document on pulmonary hypertension[J].J Am Coll Cardiol,2009,53(17):1573-1619.
[4]Malenfant S,Neyron AS,Paulin R,et al.Signal transduction in the development of pulmonary arterial hypertension[J].Pulm Circ,2013,3(2):278-293.
[5]Raymond RJ,Hinderliter AL,Willis PW,et al.Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension[J].J Am Coll Cardiol,2002,39(7):1214-1219.
[6]de Knegt MC,Fuchs A,Weeke P,et al.Optimisation of coronary vascular territorial 3D echocardiographic strain imaging using computed tomography:a feasibility study using image fusion[J].Int J Cardiovasc Imaging,2016,32(12):1715-1723.
[7]Atsumi A,Seo Y,Ishizu T,Nakamura A,et al.Right ventricular deformation analyses using a three-dimensional speckle-tracking echocardiographic system specialized for the right ventricle[J].J Am Soc Echocardiogr,2016,29(5):402-411.
[8]Leary PJ,Kurtz CE,Hough CL,et al.Three-dimensional analysis of right ventricular shape and function in pulmonary hypertension[J].Pulm Circ,2012(2):34-40.
[9]Khoo NS,Young A,Occleshaw C,et al.Assessments of right ventricular volume and function using three-dimensional echocardiography in older children and adults with congenital heart disease:comparison with cardiac magnetic resonance imaging[J].J Am Soc Echocardiogr,2009,22(11):1279-1288.
[10]李一丹,吕秀章,吴雅峰,等.实时三维超声心动图评价肺动脉高压右心室收缩功能的临床研究[J].中华超声影像学杂志,2015,24(3):191-195.
[11]Grewal J,Majdalany D,Syed I,et al.Three-dimensional echocardiographic assessment of right ventricular volume and function in adult patients with congenital heart disease:comparison with magnetic resonance imaging[J].J Am Soc Echocardiogr,2010,23(2):127-133.
[12]Puwanant S,Park M,Popovic ZB,et al.Ventricular geometry,strain and rotational mechanics in pulmonary hypertension[J].Circulation,2010,121(2):259-266.
[13]Knight DS,Grasso AE,Quail MA,et al.Accuracy and reproducibility of right ventricular quantification in patients with pressure and volume overload using single-beat threedimensional echocardiography[J].J Am Soc Echocardiogr,2015,28(3):363-374.
[14]You XD,Pu ZX,Peng XJ,et al.Tissue Doppler imaging study of right ventricular myocaddial systolic activation in Subjects with pulmonary arterial hypertension[J].Chin Med J,2007,120(13):1172-1175.
[15]郑枫,徐莉,张国辉,等.实时三维超声心动图对肺动脉高压患者右心室功能的评价[J].临床超声医学杂志,2017,19(9):631-633.
[16]周贵明,黄灿亮,万征,等.超声二维应变技术评价肺动脉高压患者右心室收缩功能[J].中国慢性病预防与控制,2010,18(4):403-405.
[17]Vitarelli A,Mangieri E,Terzano C,et al.Threedimensional echocardiography and 2D-3D speckle-tracking imaging in chronic pulmonary hypertension:diagnostic accuracy in detecting hemodynamic signs of right ventricular(RV)failure[J].J Am Heart Assoc,2015,4(3):e001584.
[18]胡路路,田新桥,周小玲,等.三维斑点追踪成像评价肺动脉高压患者右心室整体收缩功能[J].中国超声医学杂志,2015,11(31):947-977.
[19]Park JH,Kusunose K,Kwon DH,et al.Relationship between right ventricular longitudinal strain,invasive hemodynamics,and functional assessment in pulmonary arterial hypertension[J].Korean Circ J,2015,45(5):398-407.
[20]滑少华,尹静,孙梦娇,等.实时三维超声心动图在评估中、重度肺动脉高压患者右心室收缩功能中的应用价值[J].中华超声影像学杂志,2017,26(5):393-397.
[2]Abman SH,Hansmann G,Archer SL,et al.Pediatric pulmonary hypertension:guidelines from the American Heart Association and American Thoracic Society[J].Circulation,2015,132(21):2037-2099.
[3]Vallerie V,McLaughlin MD,FACC,et al.ACCF/AHA 2009expert conserlsus document on pulmonary hypertension[J].J Am Coll Cardiol,2009,53(17):1573-1619.
[4]Malenfant S,Neyron AS,Paulin R,et al.Signal transduction in the development of pulmonary arterial hypertension[J].Pulm Circ,2013,3(2):278-293.
[5]Raymond RJ,Hinderliter AL,Willis PW,et al.Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension[J].J Am Coll Cardiol,2002,39(7):1214-1219.
[6]de Knegt MC,Fuchs A,Weeke P,et al.Optimisation of coronary vascular territorial 3D echocardiographic strain imaging using computed tomography:a feasibility study using image fusion[J].Int J Cardiovasc Imaging,2016,32(12):1715-1723.
[7]Atsumi A,Seo Y,Ishizu T,Nakamura A,et al.Right ventricular deformation analyses using a three-dimensional speckle-tracking echocardiographic system specialized for the right ventricle[J].J Am Soc Echocardiogr,2016,29(5):402-411.
[8]Leary PJ,Kurtz CE,Hough CL,et al.Three-dimensional analysis of right ventricular shape and function in pulmonary hypertension[J].Pulm Circ,2012(2):34-40.
[9]Khoo NS,Young A,Occleshaw C,et al.Assessments of right ventricular volume and function using three-dimensional echocardiography in older children and adults with congenital heart disease:comparison with cardiac magnetic resonance imaging[J].J Am Soc Echocardiogr,2009,22(11):1279-1288.
[10]李一丹,吕秀章,吴雅峰,等.实时三维超声心动图评价肺动脉高压右心室收缩功能的临床研究[J].中华超声影像学杂志,2015,24(3):191-195.
[11]Grewal J,Majdalany D,Syed I,et al.Three-dimensional echocardiographic assessment of right ventricular volume and function in adult patients with congenital heart disease:comparison with magnetic resonance imaging[J].J Am Soc Echocardiogr,2010,23(2):127-133.
[12]Puwanant S,Park M,Popovic ZB,et al.Ventricular geometry,strain and rotational mechanics in pulmonary hypertension[J].Circulation,2010,121(2):259-266.
[13]Knight DS,Grasso AE,Quail MA,et al.Accuracy and reproducibility of right ventricular quantification in patients with pressure and volume overload using single-beat threedimensional echocardiography[J].J Am Soc Echocardiogr,2015,28(3):363-374.
[14]You XD,Pu ZX,Peng XJ,et al.Tissue Doppler imaging study of right ventricular myocaddial systolic activation in Subjects with pulmonary arterial hypertension[J].Chin Med J,2007,120(13):1172-1175.
[15]郑枫,徐莉,张国辉,等.实时三维超声心动图对肺动脉高压患者右心室功能的评价[J].临床超声医学杂志,2017,19(9):631-633.
[16]周贵明,黄灿亮,万征,等.超声二维应变技术评价肺动脉高压患者右心室收缩功能[J].中国慢性病预防与控制,2010,18(4):403-405.
[17]Vitarelli A,Mangieri E,Terzano C,et al.Threedimensional echocardiography and 2D-3D speckle-tracking imaging in chronic pulmonary hypertension:diagnostic accuracy in detecting hemodynamic signs of right ventricular(RV)failure[J].J Am Heart Assoc,2015,4(3):e001584.
[18]胡路路,田新桥,周小玲,等.三维斑点追踪成像评价肺动脉高压患者右心室整体收缩功能[J].中国超声医学杂志,2015,11(31):947-977.
[19]Park JH,Kusunose K,Kwon DH,et al.Relationship between right ventricular longitudinal strain,invasive hemodynamics,and functional assessment in pulmonary arterial hypertension[J].Korean Circ J,2015,45(5):398-407.
[20]滑少华,尹静,孙梦娇,等.实时三维超声心动图在评估中、重度肺动脉高压患者右心室收缩功能中的应用价值[J].中华超声影像学杂志,2017,26(5):393-397.