四维超声自动定量技术评估功能性三尖瓣反流瓣膜及右心结构与功能改变  

Evaluation of functional tricuspid regurgitant valves and right heart structural and functional changes by four-dimensional auto quantitative techniques

作　　者：蔡雍至 章晓锋 罗小菊[1] 李京涛 黄桐桐 李林燕 吴棘[1] Cai Yongzhi;Zhang Xiaofeng;Luo Xiaoju;Li Jingtao;Huang Tongtong;Li Linyan;Wu Ji(Department of Ultrasound,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院超声科,南宁530021

出　　处：《中华超声影像学杂志》2023年第5期437-443,共7页Chinese Journal of Ultrasonography

基　　金：广西自然科学基金(2017GXNSFAA198246);广西医疗卫生适宜技术开发与推广应用(S2017019);广西医学高层次人才"139"计划(G201903014)。

摘　　要：目的使用四维超声自动三尖瓣定量(4D Auto TVQ)技术、四维超声自动右室定量(4D Auto RVQ)技术、四维超声自动左房定量(4D Auto LAQ)技术综合评估不同程度功能性三尖瓣反流(FTR)患者的三尖瓣、右心解剖学特点及相关动态参数,并探讨FTR患者瓣膜及右心结构与功能改变。方法前瞻性选取2022年2-7月于广西医科大学第一附属医院经超声心动图确诊的63例FTR患者作为病例组,其中轻度FTR组30例,中度及以上FTR组33例,并选取同期30例健康受检者作为对照组。采用经胸超声心动图进行心脏二维及三维图像采集。通过二维图像测量三尖瓣反流容积、左室射血分数(LVEF)、右室整体应变(RVGS),并根据三尖瓣反流频谱估测肺动脉收缩压(PASP)。三维图像导入EchoPAC 204并通过四维自动定量技术获取三尖瓣、右心结构及相关动态参数。使用4D Auto TVQ获取瓣环面积(AA)、瓣环周长(AP)、瓣环球形指数(SI)、瓣环面积变化分数(AC)、瓣叶闭合点高度(CPH)、幕状区容量(TV)。使用4D Auto LAQ获取右房最大容积(RAVmax)、右房最小容积(RAVmin)。使用4D Auto RVQ获取右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室面积变化率(RVFAC)及三尖瓣环收缩期位移(TAPSE)。将维度参数进行体表面积(BSA)标准化后,比较三组间以上参数的差异,通过相关性分析确认反流容积与各参数间的相关性,并通过单因素与多因素线性回归分析探讨三尖瓣反流容积增加的独立因素。结果三组间PASP、AA/BSA、AP/BSA、AC、TV、RAVmax/BSA、RAVmin/BSA、RVFAC、RVGS、TAPSE差异有统计学意义(均P<0.05)。中度及以上FTR组与对照组、轻度FTR组相比,LVEF、CPH、RVEDV/BSA、RVESV/BSA差异有统计学意义(均P<0.05)。相关性分析显示在FTR患者中,RAVmin与三尖瓣反流容积呈极高度相关性(r=0.875,P<0.001),TV、收缩末期瓣环面积(ESAA)与三尖瓣反流容积呈高度相关性(r=0.747、0.683,�Objective To comprehensively evaluate the tricuspid valve,right heart anatomical characteristics and related dynamic parameters in patients with different degrees of functional tricuspid regurgitation(FTR)using four-dimensional auto tricuspid valve quantitative(4D Auto TVQ),four-dimensional auto right ventricle quantitative(4D Auto RVQ),and four-dimensional auto left atrium quantitative(4D Auto LAQ),and to investigate the structural and functional changes of the tricuspid valve and right heart in them.Methods Sixty-three patients with FTR diagnosed by echocardiography at the First Affiliated Hospital of Guangxi Medical University from February to July 2022 were prospectively selected as the case group,including 30 patients with mild FTR and 33 patients with moderate or above FTR,and 30 healthy subjects were selected as the control group.Transthoracic echocardiography was used for two-dimensional and three-dimensional image acquisition of the heart.The tricuspid regurgitation volume,left ventricular ejection fraction(LVEF),right ventricular global strain(RVGS)were measured by 2D images,and pulmonary artery systolic pressure(PASP)were measured from the tricuspid regurgitation pressure difference.The 3D images were imported into EchoPAC 204 to obtain the tricuspid valve,right heart structure and related dynamic parameters.The annulus area(AA),annulus perimeter(AP),spherical index(SI),annulus area change fraction(AC),coaptation point height(CPH),and tenting volume(TV)were measured by 4D Auto TVQ.The right atrial maximum volume(RAVmax)and right atrial minimum volume(RAVmin)were measured by 4D Auto LAQ.Right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV),right ventricular fractional area change(RVFAC)and tricuspid annular plane systolic excursion(TAPSE)were measured by 4D Auto RVQ.After standardizing the dimension parameters with body surface area(BSA),the differences in the above parameters were compared between the three groups,the correlation between regurgitant volume and each

关 键 词：四维超声自动定量技术 超声心动描记术 经胸 三维 功能性三尖瓣反流 右房容积 幕状区容量 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.53[医药卫生—诊断学]