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四维超声心动图结合二维斑点追踪技术评价肺动脉高压患者右心功能和预后 被引量:1

Value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension
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摘要 目的应用四维超声心动图结合二维斑点追踪技术评价肺动脉高压患者的右心功能及预后。方法2017年7至11月,采用前瞻性研究方法纳入2015年9月至2017年7月在上海交通大学医学院附属仁济医院东院及南院经右心导管确诊的肺动脉高压患者51例作为肺动脉高压组,同期招募年龄和性别与肺动脉高压组相匹配的健康志愿者26名作为对照组。肺动脉高压组患者年龄(45.8±15.5)岁,男性6例,女性45例;对照组年龄(45.4±14.6)岁,男性4名,女性22名。分别获取二维和四维超声心动图图像,测量右心结构和功能的相关指标,然后利用斑点追踪技术测量各心室与心房的心肌应变。肺动脉高压组患者自2017年7月随访至2018年8月,观察终点事件(包括全因死亡、再入院和临床恶化)的发生情况。结果对照组与肺动脉高压组的二维超声心动图参数[包括三尖瓣环收缩期位移(TAPSE)、右心室面积变化分数(FAC)和右心室收缩压(RVSP)]、斑点追踪技术参数[包括左心室整体纵向收缩期峰值应变(LVGLS)、右心室整体纵向收缩期峰值应变(RVGLS)、左心房储备功能(LASr)、左心房管道功能(LASc)、左心房泵功能(LASp)、右心房储备功能(RASr)、右心房管道功能(RASc)、右心房泵功能(RASp)]和四维超声心动图参数[包括右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)、右心室收缩容积(RVSV)、右心室游离壁长轴应变(RVLSf)、室间隔长轴应变(IVSLS)和右心室射血分数(RVEF)]差异均有统计学意义(P<0.01或0.05)。Spearman相关分析显示,RVEF与6min步行距离(r=0.540,P<0.001)、B型利钠肽(r=-0.545,P<0.001)、纽约心脏协会(NYHA)心功能分级(r=-0.583,P<0.001)、TAPSE(r=0.595,P<0.001)、LVGLS(r=-0.461,P=0.001)、LASc(r=0.453,P=0.002)、RASc(r=0.532,P<0.001)、RVESV(r=-0.418,P=0.004)、RVSV(r=0.351,P=0.017)和IVSLS(r=-0.450,P=0.002)均相关。Pearson相关分析显示,RVEF与FAC(r=0.579,P<0.001)、RVSP(r=-0.442, ObjectiveTo investigate the value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension (PAH).MethodsIn this prospective study, 51 patients with PAH diagnosed by right heart catheterization in east hospital and south hospital of Renji hospital affiliated to school of medicine of Shanghai Jiaotong University from September 2015 to July 2017 were enrolled as PAH group from July to November 2017. Meanwhile, 26 healthy volunteers with age and sex matched with pulmonary hypertension patients were recruited as control group. The patients were aged (45.8±15.5) years old in PAH group, and there were 6 males and 45 females. The healthy volunteers were aged (45.4±14.6) years old in control group, and there were 4 males and 22 females. Two-dimensional and four-dimensional echocardiographic images were obtained to measure the structure and function of the right heart. The myocardial strain of each ventricle and atrium was measured by sparkle tracking. The patients in PAH group were followed up from July 2017 to August 2018 to observe the endpoint events including all-cause death, re-hospitalization, and clinical deterioration.ResultsThere were significant differences in two-dimensional echocardiographic parameters(including tricuspid annular plane systolic excursion (TAPSE), right ventricular area change fraction (FAC), and right ventricular systolic pressure (RVSP)), speckle tracking parameters (including global longitudinal systolic peak strain of left ventricle (LVGLS), global longitudinal systolic peak strain of right ventricle (RVGLS),left atrial reservoir function(LASr), left atrial conduit function (LASc), left atrial pump function (LASp), right atrial reservoir function (RASr), right atrial conduit function (RASc), and right atrial pump function (RASp)), and four-dimensional echocardiographic parameters(including right ventricular end diastolic volume (RVEDV) , right ventricular end systo
作者 张学铭 庄琦 杨梦慧 王玮 郑莺 乔志卿 沈节艳 沈学东 Zhang Xueming;Zhuang Qi;Yang Menghui;Wang Wei;Zheng Ying;Qiao Zhiqing;Shen Jieyan;Shen Xuedong(Department of Cardiology,Renji Hospital (South),Shanghai Jiaotong University School of Medicine,Shanghai 201112,China)
出处 《中华心血管病杂志》 CSCD 北大核心 2018年第12期965-971,共7页 Chinese Journal of Cardiology
基金 上海交通大学医学院附属仁济南院国家自然科学基金培育项目(2017PYM03) 上海市闵行区卫生和计划生育委员会科研课题(2016MW64).
关键词 高血压 肺性 超声心动描记术 四维 心室功能 预后 Hypertension,pulmonary Echocardiography,four-dimensional Ventricular function,right Prognosis
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