超声心动图评价左心室收缩功能减退患者的右心功能  

Evaluation of Right Ventricular Function in Patients with Left Ventricular Systolic Dysfunction by Echocardiography

作　　者：张梅青[1] 李越[1] 王秋霜[1] 翟亚楠[1] 黄党生[1] 王淑华[1] 

机构地区：[1]解放军总医院第一附属医院心内科,北京100048

出　　处：《中国医学影像学杂志》2016年第10期766-770,774,共6页Chinese Journal of Medical Imaging

摘　　要：目的应用超声心动图评价不同程度左心室收缩功能减退(LVSD)患者的右心室收缩功能,探讨左、右心室收缩功能间的相互作用与影响。资料与方法选取91例LVSD患者(LVSD组)和65名健康者(对照组),测量左心室大小和射血分数(LVEF),同时检测肺动脉收缩压(PASP)和右心室收缩功能参数:右心室侧壁三尖瓣环平面位移(TAPSE)、右心室面积变化率(RVFAC)右心室侧壁三尖瓣环收缩期峰值运动速度(PSv)、三尖瓣环等容收缩期峰值速度(IVCv)。根据LVEF减退程度将LVSD组分为轻-中度LVSD组和重度LVSD组,比较各组右心室收缩功能和LVSD组肺动脉高压的发生率;进一步将相同LVSD水平者据PASP分为伴肺动脉高压和不伴肺动脉高压2个亚组,并比较组间右心室收缩功能。分析LVEF、PASP与右心室收缩功能的相关性。结果对照组、轻-中度LVSD组及重度LVSD组的TAPSE、RVFAC、PSv、IVCv依次减低(P<0.01);在轻-中度LVSD组中,伴肺动脉高压患者的RVFAC、PSv较不伴肺动脉高压进一步减低(P<0.05);在重度LVSD组中,伴肺动脉高压组的TAPSE、RVFAC、IVCv也较不伴肺动脉高压进一步减低(P<0.05);轻-中度、重度LVSD组肺动脉高压发生率分别为26.1%(12/46)和42.2%(19/45),两组比较差异无统计学意义(P>0.05);相关分析示:LVEF、PASP与TAPSE、RVFAC、PSV、IVCv呈轻到中度相关(r=0.311、0.307、0.359、0.324,P<0.05;r=-0.458、-0.541、-0.537、-0.482,P<0.01);回归分析示:LVEF与TAPSE、RVFAC、PSv、ICVv复合模型拟合最优(R^2=0.353、0.301、0.215、0.198,P<0.01);PASP与TAPSE、RVFAC、PSv、ICVv 3次模型拟合最优(R2=0.396、0.557、0.294、0.155,P<0.05),拟合模型显著。结论 LVSD患者存在不同程度的右心室收缩功能减退,右心室收缩功能减退的程度与LVSD的程度有关,并且与是否存在左心疾病相关性肺动脉高压以及肺动脉高压的程度有关。Purpose To evaluate the right ventricular function in patients with left ventricular systolic dysfunction（LVSD） by echocardiography, and to explore the interplay between left and right ventricular systolic function. Materials and Methods Ninety-one patients with reduced left ventricular ejection fraction（heart failure group） and 65 healthy volunteers（control group） underwent detailed echocardiography examination. The size of left ventricular ejection fraction（LVEF） and pulmonary arterial systolic pressure（PASP） were measured, as well as the following right ventricular systolic functions： tricuspid annular plane systolic excursion（TAPSE）, peak systolic velocity（PSv）, right ventricular fractional area change（RVFAC）, and isovolumic contraction peak velocity（IVCv）. According to the different levels of LVEF, patients were classified into mild to moderate group and severe group to compare if any significance of right ventricular systolic function and incidence of pulmonary hypertension（PH） could be found. And the same level heart failure patients were further divided into with and without PH groups to compare the right ventricular systolic function between the two groups. The correlation of PH and right ventricular systolic function was analyzed. Results The right heart systolic function TAPSE, RVFAC, PSv and IVCv of mild to moderate group and severe group were gradually reduced when compared with control group（P〈0.01）, but there was no significance in incidence of PH（26.1% vs 42.2%, P〉0.05）. In the mild to moderate group, RVFAC and PSv of the patients with PH were lower than those of the patients without PH（P〈0.05）. In the severe group, TAPSE, RVFAC and IVCv of the patients with PH were further decreased when compared with the patients without PH（P〈0.05）. LVEF and PASP were correlated with TAPSE, RVFAC, PSV and IVCv（r=0.311, 0.307, 0.359 and 0.324, P〈0.05; r=- 0.458,- 0.541,- 0.537 and- 0.482, P〈0.01）. Regression analysis showed that PASP with T

关 键 词：心力衰竭 收缩性 心室功能 左 超声心动描记术 多普勒 彩色 心室功能 右 高血压 肺性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.6[医药卫生—诊断学]