慢性血栓栓塞性肺动脉高压患者左心室功能改变及肺动脉内膜剥脱术后恢复情况  

Clinical study on the changes of left ventricular function and recovery after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

作　　者：刘格婧 李爱莉[1] 翟亚楠 吕广洁 甄雅南[2] 林凡[2] 刘晓鹏 谢万木 翟振国 Liu Gejing;Li Aili;Zhai Yanan;Lyu Guangjie;Zhen Yanan;Lin Fan;Liu Xiaopeng;Xie Wanmu;Zhai Zhenguo(Echocardiography in Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Cardiovascular Surgery,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,Clinical Research Center for Respiratory Disease,Beijing 1000299,China;Department of Geriatric Cardiology,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]中日友好医院心脏科超声心动图室,北京100029 [2]中日友好医院心血管外科,北京100029 [3]国家呼吸疾病临床研究中心呼吸与危重症医学科,北京100029 [4]兰州大学第一医院老年病科,兰州730000

出　　处：《中华超声影像学杂志》2022年第3期245-251,共7页Chinese Journal of Ultrasonography

基　　金：首都卫生发展科研专项(2020-2-4063);国家临床重点专科建设项目(2020-QTL-009)。

摘　　要：目的应用常规超声、二维斑点追踪成像及实时三维超声心动图评估慢性血栓栓塞性肺动脉高压(CTEPH)患者左室构型、收缩功能的变化及肺动脉内膜剥脱术(PEA)后的恢复情况。方法纳入2016年11月至2021年6月于中日友好医院诊断为CTEPH并行PEA手术且无左心疾病的患者30例作为CTEPH组,记录其手术前后右心导管数据;同时收集性别、年龄匹配的健康查体者23例作为对照组。比较CTEPH组PEA术前、术后与对照组间超声心动图相关指标的差异,主要包括左室舒张末期内径(LVEDd)、左右心室横径比值(RVd/LVd)、左室整体纵向应变(LVGLS)、三维左室舒、缩末容积指数(LVEDVi、LVESVi)、左室射血分数(LVEF)及左室每搏量(LVSV)。分析平均肺动脉压(mPAP)、肺血管阻力(PVR)与左室功能指标间的相关性。结果CTEPH组PEA术前LVEDd、LVEDVi、LVESVi、LVSV、LVGLS、二尖瓣口舒张期血流频谱比值(E/A)低于对照组(均P<0.05),LVEF、心排出量(CO)、心脏指数(CI)与对照组差异无统计学意义(均P>0.05)。CTEPH组PEA术后左室容积、LVSV与对照组差异无统计学意义(均P>0.05),但LVGLS、E/A仍低于对照组(均P<0.05)。相关性分析显示mPAP与LVSV、E/A呈负相关(γ=-0.490、-0.455,均P<0.05)。结论CTEPH患者左室构型改变,充盈异常,存在潜在收缩功能受损。PEA术后左室构型及容积恢复,但充盈模式、LVGLS在随访期间内尚未完全恢复。Objective To assess the configuration and systolic function of the left ventricle in patients with chronic thromboembolic pulmonary hypertension(CTEPH)by routine ultrasound,two-dimensional speckle tracking imaging and three-dimensional echocardiography,and to observe the recovery after pulmonary endarterectomy(PEA).Methods The patients who were diagnosed with CTEPH,underwent PEA and had no left heart disease were enrolled as the CTEPH group(n=30)in the China-Japan Friendship Hospital from November 2016 and June 2021.The right heart catheterization data before and after surgery were recorded.In the meantime,gender-and age-matched healthy individuals who sought for physical examination during the same period were included as the control group(n=23).Echocardiography findings before and after PEA were comparatively analyzed and compared between the two groups,including left ventricular end-diastolic diameter(LVEDd),right and left ventricular cross-section ratio(RVd/LVd),left ventricular global longitudinal strain(LVGLS),left ventricular end-diastolic/systolic volume index(LVEDVi/LVESVi),left ventricular ejection fraction(LVEF)and left ventricular stroke volume(LVSV).Associations between the mean pulmonary arterial pressure(mPAP)/pulmonary vascular resistance(PVR)and left ventricular function were discussed.Results When compared with the control group,the LVEDd,LVEDVi,LVESVi,LVSV,LVGLS and the mitral early to late diastolic flow velocity ratio(E/A)in the CTEPH group were lower(all P<0.05).There were no significant differences between the two groups regarding LVEF,cardiac output(CO),and cardiac index(CI)(all P>0.05).There were no statistical differences of the left ventricular volume and LVSV between PEA group and the control group(both P>0.05),while the LVGLS and E/A remained lower(both P<0.05).Correlation analysis showed negative associations between mPAP and LVSV as well as E/A(γ=-0.490,-0.455;both P<0.05).Conclusions There are changes in left ventricular configuration with abnormal filling pattern and potential sy

关 键 词：超声心动描记术 慢性血栓栓塞性肺动脉高压 肺动脉内膜剥脱术 左室收缩功能 左室整体纵向应变 

分 类 号：R544.1[医药卫生—心血管疾病]