二维斑点追踪技术评估右室心梗患者右心房功能的价值  

Evaluation of right atrial function by two-dimensional speckle tracking echocardiography in patients with right ventricular myocardial infarction

作　　者：栾丽娜[1] 江泉[1] 张渊[1] 陈庆[1] 胡常青[1] 黄燕[1] 杨寿强 LUAN Li-na JIANG Quan ZHANG Yuan et al(Department of Ultrasonography, Shanghai Pudong New Area People＇s Hospital, Shanghai 201299, China)

机构地区：[1]上海市浦东新区人民医院超声科,上海市201299

出　　处：《中国心血管病研究》2017年第7期614-618,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨二维斑点追踪技术（2DSTE）评估右房功能用于早期监测右室心肌梗死的价值.方法 随机入组左室下壁心肌梗死（INFMI）患者56例,其中单纯左室下壁心肌梗死（INFMI）34例、左室下壁心肌梗死合并右室心肌梗死（INFMI＋RVMI）22例,分别作为对照组及病例组.二维超声心尖四腔观测量右房上下径、左右径及面积;彩色多普勒测量三尖瓣血流图E峰值、A峰值及减速时间（DT）;组织多普勒测量三尖瓣瓣环右心室游离壁侧收缩期s′、舒张早期e′及舒张晚期a′;运用2DSTE评价右心房功能,测量右房收缩期应变（SS）、舒张早期应变（EDS）、舒张晚期应变（LDS）.结果 病例组（INFMI＋RVMI）的右房SS、LDS比对照组（INFMI）明显减低（P〈0.05）.右心房LDS截值〈6.88%时,鉴别INFMI＋RVMI与INFMI的AUC为0.834（灵敏度64.71%,特异度94.12%）;SS截值〈8.44%时,鉴别INFMI＋RVMI与INFMI的AUC为0.713（灵敏度41.18%,特异度88.24%）.结论 与INFMI患者相比,INFMI＋RVMI患者的右心房储器和收缩功能受损更为显著.二维斑点追踪技术可评价右室心梗患者的右房功能,右房LDS、SS可以提示左室心梗合并右室心梗的可能.Objective To evaluate the value of right atrial function for early monitoring of right ventricu-lar myocardial infarction by two-dimensional speckle-tracking echocardiography（2DSTE）. Methods Fifty-six pa-tients with INFMI （34 patients without RVMI and 22 patients with RVMI） were enrolled in the current study. RA diameter in anteroposterior and mediolateral directions and RA area were measured in the 4-chamber view. The myocardial peak velocity of the RV free wall in systole（s′） and early and late diastole（e′ and a′） was measured in the apical 4-chamber view at the level of the tricuspid valve annulus via pulsed-wave tissue Doppler imaging. Right atrial function was evaluated by 2DSTE. Right atrial systolic strain（SS）, early diastolic strain（EDS）, late di-astolic strain（LDS） were measured. Results SS, LDS of the right atrium were reduced in the patients with INF-MI＋RVMI compared to the patients with INFMI（P〈0.05）. The area under the curve for LDS was 0.834（P=0.001, 95%CI 0.693-0.974） and for SS was 0.713 （P=0.034, 95%CI 0.538-0.888）. Right atrial LDS〈6.88% had 64.71% sensitivity and 94.12% specificity and SS〈8.44% had 41.18% sensitivity and 88.24% specificity for the discrimination of INFMI＋RVMI from INFMI. Conclusion Our results demonstrated that right atrial reservoir and contraction functions were impaired in the patients with INFMI＋RVMI compared with the patients with INFMI. The right atrial function can be evaluated by 2DSTE in patients with RVMI. Right atrial LDS and SS can suggest RVMI in patients with INFMI.

关 键 词：心肌梗死 右心房 右心室 二维斑点追踪 

分 类 号：R542.22[医药卫生—心血管疾病]