二维斑点追踪技术评估三尖瓣反流患者右室功能的价值  

Value of two-dimensional speckle-tracking imaging in evaluating right ventricular function in patients with tricuspid regurgitation

作　　者：赵田英 赵亚子 石紫旋 申晴 张霞 ZHAO Tianying;ZHAO Yazi;SHI Zixuan;SHEN Qing;ZHANG Xia(Department of Ultrasound Medicine,the First Affiliated Hospital of Wannan Medical College,Anhui 241001,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院超声医学科,安徽省芜湖市241001

出　　处：《临床超声医学杂志》2023年第3期166-171,共6页Journal of Clinical Ultrasound in Medicine

基　　金：芜湖市科技计划项目(2020ms3-5);安徽省2017年公益性技术应用研究联动计划项目(1704f0804048)。

摘　　要：目的探讨二维斑点追踪技术(2D-STI)评估不同程度三尖瓣反流(TR)患者右室功能的应用价值。方法选取经我院超声科确诊为TR的患者78例和同期健康志愿者39例(正常对照组),TR患者根据反流程度进一步分为轻度TR患者39例(非显著TR组)和中、重度TR患者39例(显著TR组)。应用经胸超声心动图获取各组常规超声心动图参数,包括Tei指数、三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(RVFAC)、右室基底段内径、右室中间段内径、右室长轴内径、右房面积、三尖瓣环舒张末期直径、三尖瓣环径变化率(TAC)、反流面积及反流颈宽度(VCW);2D-STI获取右室游离壁纵向应变(RVGLS),比较各组上述参数的差异。分析RVGLS与各常规超声心动图参数的相关性;绘制受试者工作特征(ROC)曲线分析各参数预测TR患者右室功能障碍的效能;评估RVGLS在观察者内及观察者间的重复性。结果常规超声心动图检查结果显示,显著TR组Tei指数、TAPSE、RVFAC、右室基底段内径、右室中间段内径、右室长轴内径、右房面积、三尖瓣环舒张末期直径、TAC与非显著TR组及正常对照组比较,差异均有统计学意义(均P<0.05)。正常对照组、非显著TR组、显著TR组TAC依次减小,两两比较差异均有统计学意义(均P<0.05)。与显著TR组比较,非显著TR组反流面积和VCW均减小,差异均有统计学意义(均P<0.05)。2D-STI检查结果显示,显著TR组、非显著TR组、正常对照组RVGLS两两比较差异均有统计学意义(均P<0.05)。相关性分析显示,RVGLS与Tei指数、反流面积及VCW均呈正相关(r=0.414、0.723、0.643,均P<0.05),与TAPSE、RVFAC及TAC均呈负相关(r=-0.334、-0.440、-0.573,均P<0.05)。ROC曲线分析显示,反流面积、VCW、TAC、RVFAC、Tei指数及TAPSE预测TR患者右室功能障碍的曲线下面积分别为0.924、0.918、0.814、0.665、0.685、0.331。RVGLS在观察者内及观察者间的组内相关系数分别为0.946�Objective To explore the application value of two-dimensional speckle-tracking imaging(2D-STI)in evaluating right ventricular function in patients with different degrees of tricuspid regurgitation(TR).Methods Seventy-eight patients diagnosed as TR in ultrasound department of our hospital and 39 healthy volunteers during the same period(normal control group)were selected.Furthermore,TR patients were divided into 39 patients with mild TR(non-significant TR group)and 39 patients with moderate and severe TR(significant TR group)according to the degree of regurgitation.Conventional echocardiographic parameters of each group were obtained by transthoracic echocardiography,including Tei index,tricuspid annular plane systolic excursion(TAPSE),right ventricular fractional area change(RVFAC),right ventricular base segment diameter,right ventricular middle segment diameter,right ventricular long axis diameter,right atrial area,tricuspid ring enddiastolic diameter,tricuspid ring diameter change rate(TAC),reflux area and vena contracta width(VCW),while 2D-STI was performed to obtain right ventricular free wall longitudinal strain(RVGLS).All the above parameters were compared among the groups.The correlation between RVGLS and conventional parameters was analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of the parameters in predicting right ventricular dysfunction in TR patients.Finally,the intra-and inter-observer consistency of RVGLS were evaluated.Results Conventional echocardiography showed that there were significant difference in Tei index,TAPSE,RVFAC,right ventricular base segment diameter,right ventricular middle segment diameter,right ventricular long axis diameter,right atrial area,TAC and tricuspid ring end-diastolic diameter in significant TR group compared with non-significant TR group and normal control group(all P<0.05).TAC in normal control group,non-significant TR group and significant TR group decreased successively,with statistical significance(all P<0.05).Compared with th

关 键 词：超声心动描记术 斑点追踪 二维 三尖瓣反流 心室功能 右 

分 类 号：R540.45[医药卫生—心血管疾病]