斑点追踪法三尖瓣环位移评估肺高血压患者的右心室功能  

Evaluation of Right Ventricular Function in Patients with Pulmonary Hypertension Using Two-Dimensional Speckle Tracking of Tricuspid Annular Displacement

作　　者：吴卫华[1] 谢晓奕[1] 陆静[1] 马兰[1] 魏松霞[1] 

机构地区：[1]上海交通大学附属上海市胸科医院超声科,上海200030

出　　处：《中国临床医学》2012年第5期547-550,共4页Chinese Journal of Clinical Medicine

基　　金：上海市卫生局基金资助项目(编号:2009104)

摘　　要：目的:探讨二维斑点追踪技术测定肺高血压(简称肺高压)患者的三尖瓣环位移(tricuspid annular displacement,TAD)在评估右心室收缩功能方面的临床应用价值。方法:将经胸超声诊断为肺高压的患者共61例分为3个亚组:Ⅰ组(可疑肺高压,n=21),Ⅱ组(肯定肺高压,n=20),Ⅲ组(重度肺高压,n=20)。另选35例年龄相匹配的健康志愿者作对照组。用PhillipSonos iE33超声仪,取心尖四腔观先后采集二维(2D)及实时三维(real-time three-dimension,RT3D)图像,然后将2D图像输入QLAB6.2工作站获取三尖瓣环中点收缩期位移等参数;将RT3D图像输入TomTec工作站,用四维右心室功能分析(4DRVF)软件计算右心室射血分数(RVEF)。结果:TAD各测值与肺动脉收缩压(PASP)中度相关,与3D-RVEF高度相关。肺高压患者TAD各测值均显著低于对照组,各个亚组间TAD各测值比较差异也有统计学意义。TAD在观察者间及观察者内的差异范围分别为(0.05±1.75)mm及(-0.15±1.09)mm。结论:用二维斑点追踪显像技术测定TAD具有快速、准确及重复性好等特点,TAD能客观反映肺高压患者的右心室收缩功能。Objective：To evaluate the value of tricuspid annular displacement （TAD）, based on two-dimensional （2D） speckle tracking imaging, in the assessment of right ventricular （RV） systolic function in patients with pulmonary hypertension （PH）. Methods： Sixty-one patients with PH, aged （49.14 ± 17.66） years, were divided into 3 subgroups according to the latest guidelines on standards of diagnosing PH by echocardiography： Group 1 （suspicious PH, n= 21）, Group 2 （definite PH, n = 20） and group 3（severe PH, n= 20）. They were compared with 35 age-matched [（47.51 ± 12. 19） years] healthy volunteers. 2D and real-time three-dimensional （3D） imaging （Philips iE33, at apical four-chamber view） were obtained in all patients. The parameters of TAD were derived from off-line QLAB software （Philips Medical Systems）. 3D-RVEF was calculated by using 4D RV Function software （TomTec Imaging Systems）. Results： The parameters of TAD showed a moderate correlation with pulmonary artery systolic pressure （P〈0.01）. However, there was a higher correlation between TAD and 3D-RVEF （P〈 0.01）. The parameters of TAD in PH group were significantly lower than the corresponding values in healthy subjects （P〈 0.01）. The inter-and intra-observer variabilities for measurement of TAD were （0.05 ± 1.75） mm and （-0. 15 ± 1.09） mm, respectively. Conclusions： TAD, based on 2D speckle tracking imaging, proved to be a rapid, accurate and reproducible method in determining RV systolic function.

关 键 词：肺高血压 右心室收缩功能 斑点追踪 三尖瓣环位移 

分 类 号：R544.1[医药卫生—心血管疾病]