二维斑点追踪成像评价左心疾病相关性肺高血压患者的右心室功能  

Right ventricular function quantified by two-dimensional speckle tracking imaging in patients with left heart disease related pulmonary hypertension

作　　者：张兰[1] 任建丽[1] 王志刚[1] 王羽[2] 罗田田[1] 

机构地区：[1]重庆医科大学超声影像学研究所及附属第二医院超声科超声分子影像重庆市重点实验室,400010 [2]重庆医科大学超声影像学研究所及附属第二医院科研处 超声分子影像重庆市重点实验室,400010

出　　处：《中华超声影像学杂志》2015年第1期6-10,共5页Chinese Journal of Ultrasonography

基　　金：重庆高校创新团队建设计划（KJTD201303）;国家自然科学基金（81471675）;重庆市医学科研计划项目（20142035）

摘　　要：目的应用二维斑点追踪成像（2D-STI）技术评价左心疾病（LHD）相关性肺高血压（PH）患者的右心室功能，初步探讨其对反应性PH的诊断价值。方法健康志愿者40例，LHD相关性PH患者65例，根据肺血管阻力（PVR）分为：被动性PH组和反应性PH组。应用2D-STI测量右室游离壁基底段、中间段、心尖段纵向峰值收缩应变（LS）及整体LS，即RVLSb RVLS、RVLS和RVLSh。结果与对照组比较，反应性PH组RVLSh、RVLSf。减低（均P〈0．05）；与被动性PH组比较，反应性PH组RVLSb RVLS减低（均P〈0．05）；对照组与被动性PH组间RVLSb…RVLSf。差异均无统计学意义（均P〉O．05）。亚组间左室射血分数（LVEF）及病因学差异均无统计学意义（均P〉0．05）。RVLSbax诊断反应性PH的ROC曲线下面积为0．93，临界值为-21．86时，敏感性、特异性分别为83％、89％；RVLSfw曲线下面积为0．79，临界值为-13．84时，敏感性、特异性分别为59％、89％。结论2D-STI能够定量评价LHD相关性PH患者的右室功能。RVLSb、RVLSf。对诊断反应性PH有较高价值，并能够鉴别诊断被动性PH与反应性PH。Objective To quantify the right ventricular （RV） function in patients with left heart disease （LHD） related pulmonary hypertension （PH） by two-dimensional speckle tracking imaging （213- STI） ,and explore its potential value in diagnosis of reactive PH. Methods Forty healthy volunteers and 65 patients with LHD related PH were enrolled. PH patients were further divided into two subgroups according to pulmonary vascular resistance（PVR）： passive PH group and reactive PH group. A complete 2D-STI derived longitudinal strain of RV free wall was performed, and the basal, middle, apical longitudinal peak systolic strain （LS） and RV free wall global LS （RVLSbas, RVLSmld ,RVLSpl and RVLSfw） were measured. Results Compared to control group,RVLSba, and RVLSfw in reactive PH group decreased significantly （all P〈0.05）. Compared to passive PH group,RVLSbas and RVLSfw in patients with reactive PH decreased significantly （all P 〈0.05）. The differences of RVLSbas and RVLSfw between control group and passive PH group had no statistical significance （all P 〉0.05）. No significant differences in etiology and left ventricular ejection fraction （LVEF） were observed between PH subgroups （all P 〉0.05）. The area under the ROC curve of RVLSbas in predicting reactive PH was 0.93, the cut-off value was -21.86,and the sensitivity and specificity were 83% and 89% ,respectively. The area under the ROC curve of RVLSfw was 0.79,the cut-off value was - 13.84,and the sensitivity and specificity were 59% and 89%,respectively. Conclusions 2D-STI can realize quantitative assessment of RV function in patients with LHD related PH. RVLSbas, and RVLSfw may have important clinical value in diagnosing patients with reactive PH, and differential diagnosis value between patients with

关 键 词：超声心动描记术 心室功能 右 高血压 肺性 二维斑点追踪显像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R544.1[医药卫生—诊断学]