超声心动图与心脏磁共振显像评估心房颤动患者右心室结构及功能的相关性  

Relationship between echocardiographic and magnetic resonance derived measures of right ventricular size and function in patients with atrial fibrillation

作　　者：刘颖娴[1] 方理刚[1] 陈未[1] 王怡宁[1] 曹剑[1] 高鹏[1] 杨德彦[1] 王佳丽[1] 常龙[1] 方全[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院心内科,100730

出　　处：《中国心血管杂志》2015年第2期90-94,共5页Chinese Journal of Cardiovascular Medicine

基　　金：北京市科委2011年度科技计划重大项目(D11110700300000)~~

摘　　要：目的超声心动图右室功能指标是否适用于心房颤动患者评估的研究甚少。本研究以心脏磁共振显像(MRI)为金标准,对超声心动图评价心房颤动患者右心结构及功能的敏感性、特异性及阈值进行了探讨。方法 2014年9—12月前瞻性收集北京协和医院心内科16例心房颤动患者,收集临床资料、超声心动图参数,同期行MRI检查。储存心尖四腔心切面二维动态图像,Echo Pac软件生成右室各层心肌的应变曲线。结果左室舒张末内径与MRI左室舒张末容积,左房前后径、右房横径与MRI相应内径,右室舒张末及收缩末面积与MRI右室容积均明显相关。右室心肌中层收缩期纵向峰应变(PLSS-MID)、侧壁三尖瓣环收缩期位移(TAPSE)及组织多普勒侧壁三尖瓣环收缩期峰速度(S')与MRI右室射血分数(MRI-RVEF)呈线性相关。ROC曲线分析显示,右心收缩功能参数中PLSS-MID的曲线下面积最大(0.836),其绝对值<17%诊断右室收缩功能减低的敏感度(0.909)、特异度(0.800)较高。Bland-Altman分析中,2.5×PLSS-MID与MRI-RVEF一致性较好。以RVEF是否<48%进行分组,则RVEF下降组心房颤动患者心内膜PLSS、PLSS-MID及心外膜PLSS均低于RVEF正常的心房颤动患者,其中心内膜PLSS受损最为明显(-18.4%比-23.9%,P=0.011)。结论现有右室收缩功能参数中S'、TAPSE同样适用于心房颤动患者;斑点追踪技术所得PLSS对RVEF下降的敏感性、特异性更好;2.5×PLSS-MID有助于预测MRI-RVEF。推荐联合TAPSE、S'以及PLSS等多种指标来进行心房颤动患者右室功能不全的筛查。Objective It is uncertain that systolic functional markers in ASE 2009 guidelines for echocardiographic assessment of the right heart are suitable to patients with atrial fibrillation （AF）. Using magnetic resonance imaging （MRI） as a gold standard, we detected the sensitivity, specificity and threshold of echocardiographic right ventricular markers in AF patients. Methods A total of 16 patients with AF were enrolled in PUMCH from Sep. 2014 to Dec. 2014, prospectively collecting their clinical data, echocardiographic and MRI values. Storing 2D movie images from apical four-chamber view, then using EchoPac system to draw time-strain curves of the endocardium, middle-layer and epicardial layers. Results There were significantly positive correlations of left and right atrial diameters between echocardiography and MRI. Both right ventricular end diastolic area and right ventricular end systolic area were related to MRI＆amp;nbsp;right ventricular volumes. Binary logistic regression showed that MRI right ventricular ejection factor （MRI-RVEF） was linearly dependent with right ventricular middle-layer peak longitudinal systolic strain （ PLSS-MID）, tricuspid annular plane systolic excursion （TAPSE） and tricuspid annular systolic peak speed （S＇）. In ROC analysis, PLSS-MID got the largest area under curve （0. 836） among all the right ventricular functional markers. - 17% could be regarded as a threshold of right ventricular dysfunction （0. 909 of sensitivity and 0. 800 of spectivity）. In Bland-Altman analysis, 2. 5 multiply PLSS-MID was consistent with MRI-RVEF. AF patients with RVEF 〈 48% had lower endocardium-PLSS than RVEF ≥48% subgroup （ - 18. 4% vs. - 23. 9% , P = 0. 011）. Conclusions S＇ and TAPSE, which are recommended by ASE guidelines, can also be applied to AF patients, while PLSS-MID has better sensitivity and specificity to identify right ventricular systolic dysfunction. 2. 5 multiply PLSS-MID can help evaluate RVEF. We propose a combination of TAPSE, S＇ and PLSS t

关 键 词：心房颤动 超声心动描记术 放射性核素显像 心室功能 右 

分 类 号：R541.75[医药卫生—心血管疾病]