FWLS和超声右心功能指标在评价CTEPH患者右心功能不全中的价值  

The value of FWLS and echocardiography in evaluating right ventricular dysfunction in chronic thromboembolic pulmonary hypertension(CTEPH)patients

作　　者：朱翔宇[1] 孙丽艳 闫志慧 Zhu Xiangyu;Sun Liyan;Yan Zhihui(Dezhou People's Hospital,Dezhou 253000,China;Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Affiliated Hospital of Jining Medical University,Jining 273100,China)

机构地区：[1]德州市人民医院,253000 [2]北京中医药大学东直门医院,100700 [3]济宁医学院附属医院,273100

出　　处：《国际医药卫生导报》2020年第15期2243-2247,共5页International Medicine and Health Guidance News

摘　　要：目的探究右室游离壁长轴应变(FWLS)和超声右心功能指标在评价慢性血栓性栓塞症肺动脉高压(CTEPH)患者右心功能不全(RVD)中的应用价值。方法前瞻性地选取2017年10月至2019年10月本院收治的139例慢性肺血栓栓塞症(PE)患者作为研究对象,单纯PE记为A组(43例)、CTEPH且右心功能正常者记为B1组(47例)、CTEPH且RVD记为B2组(49例),行超声、二维斑点追踪技术、右心漂浮导管等检查,获取相关指标,并行单因素方差分析、相关性分析及ROC曲线分析。结果不同患者平均肺动脉压(mPAP)、肺小动脉楔压(PCWP)、超声参数及FWLS差异均有统计学意义(均P<0.05),其中A组患者mPAP、右室横径(RVTD)、右室心肌做功指数(RVIMP)显著低于B1组、B2组(均P<0.05),而PCWP、三尖瓣收缩期位移(TAPSE)、三尖瓣环收缩期峰值速度(s′)、右室面积变化率(FAC)、FWLS显著高于B1组、B2组(均P<0.05)。B1组mPAP、RVTD显著低于B2组(均P<0.05),PCWP、TAPSE、FAC、FWLS显著高于B2组(均P<0.05)。相关性分析结果显示,FWLS与mPAP、PCWP、RVTD、TAPSE、s′、RVIMP、FAC呈一定相关性(均P<0.05)。预测价值分析显示,RVTD、TAPSE、s′、RVIMP、FAC、FWLS均有一定的诊断价值(均P<0.05),联合诊断的价值更高,联合诊断的AUC、敏感度、特异度分别为0.876、0.978、0.759。结论FWLS、超声右心功能指标对CTEPH伴RVD均有一定的诊断效果,两者联合可提升诊断价值。Objective To explore the value of right ventricular free wall longitudinal strain(FWLS)and right ventricular function index of ultrasound in the evaluation of right ventricular dysfunction(RVD)in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods 139 patients with chronic pulmonary thromboembolism(PE)treated in our hospital from October 2017 to October 2019 were selected prospectively,43 patients with PE alone as group A,47 patients with CTEPH and normal right heart function as group B1,49 patients with CTEPH and RVD as group B2.All patients underwent ultrasound,two-dimensional speckle tracking imaging,and right heart floating catheters.Univariate analysis of variance,correlation analysis,and ROC curve analysis were performed for relevant indicators of all patients.Results The mean pulmonary arterial pressure(mPAP),pulmonary arterial wedge pressure(PCWP),ultrasound parameters,and FWLS of patients in different groups were significantly different(all P<0.05).Among them,the mPAP,right ventricular transverse diameter(RVTD),and right ventricular index of myocardial performance(RVIMP)of patients in group A were significantly lower than those of patients in group B1 and B2(all P<0.05),while the PCWP,tricuspid annular plane systolic excursion(TAPSE),tricuspid annular peak systolic velocity(s'),fractional area change(FAC),and FWLS in group A were significantly higher than those in group B1 and B2(all P<0.05).The mPAP and RVTD of group B1 were significantly lower than those of group B2(all P<0.05),the PCWP,TAPSE,FAC,and FWLS of group B1 were significantly higher than those of group B2(all P<0.05).Correlation analysis results showed that FWLS was correlated with mPAP,PCWP,RVTD,TAPSE,s',RVIMP,and FAC(all P<0.05).The predictive value analysis showed that RVTD,TAPSE,s',RVIMP,FAC,and FWLS all had certain diagnostic value(all P<0.05).The value of combined diagnosis was higher,and the AUC,sensitivity,and specificity of combined diagnosis were 0.876,0.978,0.759,respectively.Conclusion FWLS and ultrasound ri

关 键 词：慢性血栓性栓塞症肺动脉高压(CTEPH) 右心功能不全(RVD) 游离壁长轴应变(FWLS) 超声 应用价值 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563.5[医药卫生—诊断学]