终末期心力衰竭患者三维右心室纵向形变与心肌纤维化的相关性  

The relationship between three-dimensional right ventricular longitudinal deformation and myocardial fibrosis in patients with end-stage heart failure

作　　者：田芳艳 李玉曼 张艳婷 谷颖 张蓓 谢明星[2,3,4] Tian Fangyan;Li Yuman;Zhang Yanting;Gu Ying;Zhang Bei;Xie Mingxing(Deparment of Ultrasound,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China;Department of Ultrasonography,Union Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Clinical Research Center for Medical Imaging in Hubei Province,Wuhan 430022,China;Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,China)

机构地区：[1]贵州医科大学附属医院超声中心,贵阳550004 [2]华中科技大学同济医学院附属协和医院超声影像科,武汉430022 [3]湖北省影像医学临床医学研究中心,武汉430022 [4]分子影像湖北省重点实验室,武汉430022

出　　处：《中华超声影像学杂志》2021年第5期376-381,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨三维斑点追踪成像(3D-STE)右室游离壁纵向应变(RVFWLS)预测终末期心力衰竭(heart failure,HF)患者心肌纤维化(MF)的价值。方法连续纳入2018年6月至2019年12月华中科技大学同济医学院附属协和医院拟行心脏移植术的终末期HF患者102例。心脏移植术前行超声检查,获取患者常规右室功能参数:右室面积变化率、三尖瓣环收缩期位移(TAPSE)、心肌做功指数、三尖瓣环收缩期速度(Tricuspid s′);应用二维斑点追踪成像(2D-STE)技术获取2D-RVFWLS;应用3D-STE获取右室舒张末期容积(RVEDV)、右室收缩末期容积(RVSDV)、右室心博量(RVSV)、右室射血分数(RVEF)、3D-RVFWLS。心脏移植术后获取右室心肌组织,行Masson′s染色定量右室MF,根据组织学MF严重程度将患者分为轻度、中度、重度组。比较三组间各超声参数的差异,并对各超声参数与右室MF行Pearson相关分析及多元逐步线性回归分析。结果与轻度组、中度组相比,重度组3D-RVFWLS、2D-RVFWLS及常规右室功能参数显著减低(均P<0.05)。右室MF与3D-RVFWLS呈强相关(r=-0.71,P<0.01),与2D-RVFWLS呈中等相关(r=-0.53,P<0.01),与RVFAC、TAPSE、RVEF、Tricuspid s′、RVSV呈弱相关(r=-0.47、-0.44、-0.35、-0.29、-0.38,均P<0.01)。相比于2D-RVFWLS及常规右室功能参数,3D-RVFWLS与右室MF相关性最好(r=-0.71对r=-0.29~-0.53,均P<0.05)。多元逐步线性回归分析显示3D-RVFWLS与右室MF独立相关(β=1.554,P<0.01,校正R^(2)=0.539)。结论3D-RVFWLS可为临床检测终末期HF患者右室MF程度提供有价值的影像学参考。Objective To investigate the values of right ventricular free wall longitudinal strain(RVFWLS)by three-dimensional speckle tracking echocardiography(3D-STE)in predicting the degree of RV myocardial fibrosis(MF)in patients with end-stage heart failure(HF).Methods A total of 102 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in the Union Hospital of Tongji Medical College,Huazhong University of Science and Technology from June 2018 to December 2019.Echocardiographic examinations were performed in these patients before heart transplantation.The conventional RV function parameters were obtained,including fractional area change,tricuspid annular plane systolic excursion(TAPSE),myocardial performance index,tricuspid lateral annular systolic velocity(Tricuspid s′).Two-dimensional(2D)RVFWLS was calculated by two-dimensional speckle tracking echocardiography(2D-STE).Right ventricular(RV)end-diastolic volume(RVEDV),RV end-systolic volume(RVESV),RV stroke volume(RVSV),RV ejection fraction(RVEF)and 3D-RVFWLS were measured by 3D-STE.The degree of MF was quantified using Masson′s trichrome stain in RV myocardial samples after heart transplantation.Patients were divided into mild,moderate,and severe groups according to the degree of MF on histology,then echocardiographic parameters were compared among the 3 groups.Pearson correlation analysis and the multiple linear regression analysis between echocardiographic parameters and RV MF were analyzed.Results Compared with patients with mild and moderate MF,3D-RVFWLS,2D-RVFWLS and conventional parameters of RV function were significantly decreased in patients with severe MF.RV MF strongly correlated with 3D-RVFWLS(r=-0.71,P<0.01),modestly correlated with 2D-RVFWLS(r=-0.53,P<0.01),and weakly correlated with RVFAC,TAPSE,RVEF,Tricuspid s′,RVSV(r=-0.47,-0.44,-0.35,-0.29,-0.38;all P<0.01).3D-RVFWLS correlated best with the degree of MF compared with 2D-RVFWLS and conventional RV function parameters(r=-0.71 vs r=-0.29~-0.53,all P<0.05).A stepwis

关 键 词：三维斑点追踪成像 应变 终末期心力衰竭 心肌纤维化 心室功能 右 

分 类 号：R541.6[医药卫生—心血管疾病] R542.23[医药卫生—内科学]