摘要
目的:应用二维斑点追踪(2D-STE)技术评价不同等级左室舒张功能不全(LVDD)的心力衰竭(HF)患者的右室功能。方法:对2018年10月至2019年9月重庆医科大学附属第二医院16例射血分数减低型心力衰竭患者(HFrEF组)、86例射血分数保留型心力衰竭患者(HFpEF组)及29例健康志愿者(对照组)行彩色多普勒超声心动图检查,并根据2016年ASE指南对HFpEF患者进行LVDD分级,其中左室舒张功能正常9例,LVDD 1级47例,LVDD 2级23例,LVDD 3级7例。于心尖四腔心切面获得常规超声参数:右室基底段内径(RVD1)、中间段内径(RVD2)、长轴内径(RVD3)、右室收缩末期面积(ESA)、舒张末期面积(EDA)、面积变化分数(FAC)、三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期峰值速度(S′)、心肌做功指数(MPI);应用2D-STE技术获得右室游离壁基底段应变(RVLSbas)、中间段应变(RVLSmid)、心尖段应变(RVLSapi)及游离壁整体应变(RVLSfw)。比较各组间二维应变参数,分析RVLSfw与常规超声参数的相关性。结果:①对照组、HFpEF组及HFrEF组中TAPSE及S′呈依次递减的趋势(均 P<0.05)。HFpEF各亚组中,LVDD 3级组的TAPSE、S′小于左室舒张功能正常组、LVDD 1级组和LVDD 2级组(均 P<0.05)。②在对照组、HFpEF组及HFrEF组中,RVLSbas、RVLSmid、RVLSfw呈依次递增的趋势(均 P<0.05)。LVDD 1级组、LVDD 2级组、LVDD 3级组之间RVLSbas、RVLSmid、RVLSapi、RVLSfw呈依次递增趋势(均 P<0.05)。③在对照组、HFpEF、HFrEF三组中,RVLSfw与左室射血分数(LVEF)呈强相关( r=0.77, P<0.01),与年龄、TAPSE、S′呈中等相关( r=0.41、-0.48、0.40, P<0.01)。在HFpEF各亚组中,RVLSfw与舒张功能呈中等相关( r=0.59, P<0.01),与年龄呈弱相关( r=0.21, P<0.01),与B型利钠肽(BNP)、FAC、TAPSE呈弱相关( r=0.28、-0.29、-0.29,均 P<0.01)。 结论:2D-STE技术能够早期发现HFpEF患者右室收缩功能受损的变化。
Objective To evaluate the right ventricular(RV)function by two-dimensional speckle tracking echocardiography(2D-STE)in heart failure patients with different left ventricle diastolic dysfunction grade.Methods Twenty-nine healthy volunteers(control group),sixteen heart failure patients with reduced ejection fraction(HFrEF group)and eighty-six heart failure patients with preserved ejection fraction(HFpEF group)were enrolled in the Second Affiliated Hospital of Chongqing Medical University from October 2018 to September 2019.HFpEF patients were further divided into four subgroups according to recommendations of the American Society of Echocardiography in 2016:normal left ventricular diastolic function group and left ventricular diastolic dysfunction groups with grade 1,2,3(LVDD1,LVDD2,LVDD3).Conventional ultrasonic parameters were obtained in apical four-chamber images,including RV basal diameter(RVD1),RV middle diameter(RVD2)and RV longitudinal diameter(RVD3),RV end diastolic area(EDA),end systolic area(ESA)and fractional area change(FAC),peak systolic velocity(S′),myocardial performance index(MPI),tricuspid annular plane systolic excursion(TAPSE).2D-STE was performed to observe strain parameters,including basal,middle,apical and the whole longitudinal peak systolic strain of RV free wall respectively(RVLSbas,RVLSmid,RVLSapi and RVLSfw).Then 2D strain parameters were compared among these groups,and the correlation between 2D strain parameters and conventional ultrasonic parameters were analyzed.Results①TAPSE and S′gradually decreased in normal group,HFpEF group and HFrEF group(all P<0.05).For the four subgroups of HFpEF,compared to LVDD3,TAPSE、S′increased significantly in normal group,LVDD1 and LVDD2(all P<0.05).②RVLSbas,RVLSmid,RVLSfw gradually increased in control group,HFpEF group and HFrEF group(all P<0.05).The same trend appeared in group LVDD1,LVDD2 and LVDD3(all P<0.05).③In control group,HFpEF group and HFrEF group,RVLSfw showed strong correlation with LVEF(r=0.77,P<0.01)and middle correlation w
作者
刘修颖
孙阳
冉海涛
王志刚
Liu Xiuying;Sun Yang;Ran Haitao;Wang Zhigang(Department of Ultraound,the Second Affiliated Hospital of Chongqing Medical University,Chongqing Key Laboratory of Ultrasound Molecular Imaging,Chongqing 400010,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2020年第7期564-570,共7页
Chinese Journal of Ultrasonography
基金
国家自然科学基金(81871369)。
关键词
超声心动描记术
二维斑点追踪技术
心力衰竭
心室功能
右
舒张功能不全分级
Echocardiography
Two-dimensional speckle tracking imaging
Heart failure
Ventricular function,right
Diastole dysfunction grade
