超声斑点追踪组织瓣环位移技术及右心室面积变化率定量评价肺动脉高压患者右室收缩功能  

Quantitative evaluation of right ventricular systolic function in patients with pulmonary hypertension by ultrasound speckle tracking tricuspid annulus displacement technique and right ventricular fractional area change

作　　者：卜德华[1] 黄文凡[1] 

机构地区：[1]杭州市余杭区第一人民医院超声科,浙江杭州311100

出　　处：《医学影像学杂志》2016年第7期1212-1216,共5页Journal of Medical Imaging

摘　　要：目的应用超声斑点追踪技术检测三尖瓣环组织位移(TAD)及右心室面积变化率(RVFAC)定量评价肺动脉高压患者右心室长轴收缩功能,探讨TAD参数与RVFAC相关性,并寻找最佳超声诊断临界值。方法肺动脉高压患者33例和体检健康的成年人35例,首先采用二维超声心动图于四腔心切面测量右心室面积变化率(RVFAC),TAD技术测量三尖瓣环室间隔侧、游离壁侧、前壁侧及后壁侧四个位点的最大位移(TAD1、TAD2、TAD3、TAD4),三尖瓣环中点收缩期最大瓣环位移(TAD-midpt),单平面三尖瓣环中点收缩期标准化瓣环位移(TADs-midpt%)、双平面三尖瓣环中点收缩期标准化瓣环位移(TADd-midpt%),比较两组上述参数,并将三尖瓣环位移指标与RVFAC做相关性分析,并通过受试者工作特性曲线(ROC)寻找各参数的最佳超声诊断临界值。结果与对照组相比,肺动脉高压组三尖瓣环四个位点TAD、四腔心及三腔心TAD-midpt、TADs-midpt%及双平面TADd-midpt%均低于对照组(均P<0.01)。相关性分析显示,以上参数与RVFAC呈正相关(相关系数分别为r=0.607、0.671、0.819、0.786、0.804、0.863、0.731、0.743、0.801、0.926,P<0.01),ROC分析显示TADd-midpt%曲线下面积最大,其诊断截断值为16.26%,诊断敏感性88.6%,特异性84.8%。结论斑点追踪组织瓣环位移技术能够定量评价肺动脉高压患者右心室长轴整体收缩功能,其获得数据与RVFAC具有良好的相关性,其中TADd-midpt%相关性及敏感度、特异度最高。Objective To quantitatively evaluate right ventricular long axis systolic function in patients with pulmonary hypertension by ultrasonic speckle tracking tricuspid annulus displacement （TAD） technique and right ventricular fractional area change （RVFAC） and tiscuss the correlation between TAD parameters and RVFAC. Methods 33 patients with pulmonary hypertension （ PH group） and 35 healthy adults（ Control group） were enrolled, RVFAC and peak systolic displacements of tricuspid annulus at right ventricular septum wall （ TAD1 ） free wall （TAD2） anterior wall （ TAD3 ） terior wall （TAD4） tricuspid annulus midpoin （TAD-midpt） and standardizing displacements （TADs-midpt%, TADd-midpt% ） were acquired at the apical four chamber view and the apical three-chamber right ventricular view. We compared the two group parameters, made correlation analysis between TAD and RVFAC, and obtained the best value ultrasonic diagnosis parameters by ROC. Results Compared with the control group, three wall TAD, TAD-midpt, TADs-midpt% and TADd-midpt% were lower （ all P 〈 0.01 ）. The correlation analysis showed that the above parameters were positive correlation with RVFAC （ r = 0. 607, 0. 671, 0. 819, 0. 786, 0. 804, 0. 863, 0. 731, 0. 801, 0. 926, all P 〈 0. 01 ）, and the diagnostic cut off value of TADd-midpt% was 16.26%, the diagnostic sensitivity was 88.6%, specificity was 84.8%. Conclusion Speckle tracking TAD technique can quantitatively evaluate the systolic function of right ventricular long axis in patients with pulmonary hypertension, TAD parameters and RVFAC have correlation, the correlation and sensitivity of TADd-midpt% are the highest.

关 键 词：三尖瓣环位移 肺动脉高压 右心室 收缩 

分 类 号：R541[医药卫生—心血管疾病] R445.1[医药卫生—内科学]