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二维斑点追踪技术评价肺动脉高压患者右心房功能变化的研究

The change of right atrial function in patients with pulmonary hypertension:a study with two-dimensional speckle-tracking echocardiography

摘要:

目的 应用二维斑点追踪技术探讨肺动脉高压患者右心房功能变化及其对WHO心功能分级的预测作用.方法 收集肺动脉高压患者54例和24例相匹配的健康志愿者.应用二维斑点追踪技术评价右心房应变,包括舒张期正向应变(LSpos)、主动收缩期负向应变(LSneg)及两者绝对值之和(LStot).右心房各时相功能参数包括整体排空分数(TotEF)、被动排空分数(PassEF)、主动排空分数(ActEF).评价LStot与肺血流动力学、心脏结构和功能之间的关系.结果 与对照组相比,肺动脉高压组患者LStot、TotEF、LSpos 及RA PassEF均明显减低(均P<0.01),而ActEF/TotEF在WHO心功能分级Ⅱ、Ⅲ级中升高(均P<0.05),在WHO功能分级Ⅳ级中降低(P<0.001).LStot与右心房面积及右心房压力呈负相关(均P<0.01).LStot与右心室功能参数及负荷过重参数有相关性(均P<0.05).LStot对肺动脉高压患者WHO心功能分级≥Ⅲ级有预测价值(AUC=0.770,P=0.002).结论 肺动脉高压患者右心房储器功能及管道功能减低,WHO心功能分级Ⅱ、Ⅲ级肺动脉高压患者右心房主动收缩功能增加,WHO心功能分级Ⅳ级患者主动收缩功能降低.LStot可以预测肺动脉高压患者的WHO心功能分级,提示患者预后.

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abstracts:

Objective To assess the right atrial(RA) function using two-dimensional speckle-tracking echocardiography(2D-STE) and the value of predicting WHO functional class in patients with pulmonary hypertension(PH).Methods Fifty-four consecutive PH patients were studied and compared with a control group of 24 healthy volunteers.RA function was evaluated by 2D-STE,and the following parameters were recorded:an average longitudinal strain (LS) curve that included LSpos during RA filling and LSneg representing RA active contraction (their summation is LStot),the phasic RA volumes,total RA emptying fraction (TotEF),RA passive(PassEF) and active emptying fraction(ActEF).The associations between these indices and the results of invasive pulmonary hemodynamics,cardiac structure and function level were evaluated.Results LStot,TotEF,LSpos,PassEF were significantly lower in PH patients than in controls(all P<0.01).ActEF/TotEF were significantly higher in WHO functional class (WHO-FC) Ⅱ and WHO-FC Ⅲ patients than in controls(all P<0.05),while were lower in WHO-FCIV patients than in controls(P<0.001).Among PH patients,LStot was negatively correlated with greater RA size and RA pressure (all P<0.01).LStot was also associated with right ventricular (RV) functional and overload parameters.In receiver-operator characteristic analysis,RA LStot was of optimal accuracy for prediction of WHO-FC≥Ⅲ in PH patients (P=0.002).Conclusions PH is associated with impaired reservoir and conduit function,but active contract function of RA is enhanced in WHO-FC Ⅱ and WHO-FC Ⅲ patients,and reduced in WHO-FCIV patients.RA LStot confers an optimal predictive effect of poor WHO-FC in PH patients and indicating prognosis.

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作者: 孟祥丽 [1] 李一丹 [1] 李虹 [1] 王怡丹 [1] 朱维维 [1] 蔡绮哲 [1] 吕秀章 [1]
期刊: 《中华超声影像学杂志》2017年26卷6期 472-477页 ISTICPKUCSCD
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.1004-4477.2017.06.003
发布时间: 2017-08-28
基金项目:
国家自然科学基金面上项目 首都临床特色应用研究项目 北京市卫生系统215高层次人才学科骨干 Natural Science Foundation of China Fund of the Health Development and Scientific Research of Capital Projects Beijing Excellent Talent Training Plan
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