二维斑点追踪超声心动图评价术前肺动脉高压对移植心脏右室功能的影响  

Effect of preoperative pulmonary hypertension on right ventricular function of cardiac allograft assessed by two-dimensional speckle tracking echocardiography

作　　者：张鑫 朱双双 吴文谦 李贺[1] 方凌云[1] 刘曼薇[1] 周羿 赵杨[1] 张丽[1] 李玉曼[1] 王国华[2] 陈澍[2] 董念国[2] 谢明星[1] Zhang Xin;Zhu Shuangshuang;Wu Wenqian;Li He;Fang Lingyun;Liu Manwei;Zhou Yi;Zhao Yang;Zhang Li;Li Yuman;Wang Guohua;Chen Shu;Dong Nianguo;Xie Mingxing(Department of Ultrasound Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Clinical Research Center for Medical Imaging in Hubei Province,Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,China;Department of Cardiovascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院超声医学科、湖北省影像医学临床医学研究中心、分子影像湖北省重点实验室,武汉430022 [2]华中科技大学同济医学院附属协和医院心脏大血管外科,武汉430022

出　　处：《中华超声影像学杂志》2022年第12期1013-1020,共8页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82001852,82001854);湖北省重点研发计划项目(2020DCD015);湖北省自然科学基金(2020CFB781)。

摘　　要：目的:探讨术前肺动脉高压(PH)对心脏移植患者术后1年右室功能的影响。方法:回顾性纳入2017年1月至2020年1月于华中科技大学同济医学院附属协和医院行心脏移植患者120例。根据术前右心导管获得的肺动脉平均压(mPAP)将研究对象分为肺动脉高压组(PH组,81例)和不伴肺动脉高压组(NPH组,39例)。获取超声心动图右室功能常规二维参数包括右室面积变化率(RV-FAC)、三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期峰值速度(S′),二维斑点追踪成像(2D-STI)应变参数包括右室整体纵向应变(RV-GLS)及右室游离壁纵向应变(RV-FWLS),以评估移植心脏右室功能。比较两组患者右室功能的差异及其与术前mPAP间的相关性。结果:与NPH组比较,PH组RV-GLS、RV-FWLS绝对值减低(均P<0.01),而常规右室功能参数RV-FAC、TAPSE、S′差异无统计学意义(均P>0.05)。术前mPAP与RV-FWLS、RV-GLS呈中等相关(r_(s)=-0.46、-0.54,均P<0.05),而与RV-FAC、TAPSE、S′无明显相关性(均P>0.05)。结论:心脏移植患者术前PH与术后1年右室功能相关,术前合并PH的心脏移植患者术后1年RV-FWLS、RV-GLS绝对值减低,2D-STI较常规超声心动图可更加敏感地监测心脏移植患者术后右室功能变化。Objective To investigate the effect of preoperative pulmonary hypertension(PH)on right ventricular function in patients with heart transplantation(HTx)one year after surgery.Methods A total of 120 patients who underwent HTx in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2017 to January 2020 were retrospectively recruited.According to the mean pulmonary arterial pressure(mPAP)obtained by preoperative right heart catheterization,the research subjects were divided into the pulmonary hypertension group(PH group,n=81)and without pulmonary hypertension group(NPH group,n=39).Conventional echocardiographic indices of right ventricular function such as right ventricular area change(RV-FAC),tricuspid annular plane systolic excursion(TAPSE),tricuspid lateral annular systolic velocity(S′),and two-dimensional speckle tracking imaging(2D-STI)strain parameters including right ventricular global longitudinal strain(RV-GLS),right ventricular free wall longitudinal strain(RV-FWLS)were obtained to assess the right ventricular function of grafted hearts.The echocardiographic parameters one year after the operation of the two groups were analyzed to compare the differences in right ventricular function and their correlation with preoperative mPAP.Results The grafted heart RV-GLS and RV-FWLS were significantly decreased in the PH group(all P<0.01),while RV-FAC,TAPSE,and S′were similar between the two groups(all P>0.05).RV-FWLS and RV-GLS correlated with preoperative hemodynamic parameter mPAP(r_(s)=-0.46,-0.54;all P<0.05)while RV-FAC,TAPSE,and S′were not significantly correlated with mPAP(all P>0.05).Conclusions Preoperative PH correlates with right ventricular function in HTx patients 1 year after the operation.The absolute values of RV-FWLS and RV-GLS in HTx patients with preoperative PH decrease 1 year after the operation.2D-STI is more sensitive than conventional echocardiography to monitor the changes in right ventricular function in HTx patients after the operation.

关 键 词：超声心动描记术 斑点追踪成像 心脏移植 高血压 肺性 心室功能 右 

分 类 号：R654.2[医药卫生—外科学] R540.45[医药卫生—临床医学]