经胸实时三维超声心动图评估心房颤动合并功能性三尖瓣反流患者右心形态结构改变的研究  

Right Heart Morphological Changes Evaluated With Real-time Three-dimensional Echocardiography in Patients With Atrial Fibrillation and Functional Tricuspid Regurgitation

作　　者：吴碧君[1] 赵萍[2] 杨瑶琳 WU Bijun;ZHAO Ping;YANG Yaoin(Department of Ultrasound,Guangdong Second Provincial General Hospital,Guangzhou 510317,China;Department of Ultrasound,The First Affiliated Hospifal of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Cardiology,Guangdong Second Provincial General Hospital,Guangzhou 510317,China)

机构地区：[1]广东省第二人民医院超声科,广州510317 [2]广州中医药大学第一附属医院超声科,广州510405 [3]广东省第二人民医院心内科,广州510317

出　　处：《中国循环杂志》2023年第11期1127-1133,共7页Chinese Circulation Journal

摘　　要：目的:应用经胸实时三维超声心动图观察心房颤动合并功能性三尖瓣反流(FTR)患者右心形态结构的改变。方法:选取2021年10月至2022年11月于广东省第二人民医院就诊的长期(≥1年)持续性孤立心房颤动合并FTR的患者80例,根据三尖瓣反流缩流颈宽度(VCW)分为轻度(VCW<3.0 mm,n=30)、中度(VCW 3.0~6.9 mm,n=30)、重度(VCW≥7.0 mm,n=20)FTR三组,选取同期33例窦性心律患者为对照组。将三维数据导入EchoPAC204工作站进行离线分析,获取右心房最大容积(RAVmax)与最小容积(RAVmin)、右心室舒张末期容积指数(RVEDVI)、右心室射血分数(RVEF)、左心室舒张末期容积指数(LVEDVI)、左心室射血分数(LVEF)及三尖瓣参数[包括瓣环周长(AP)、三维瓣环面积(3D-AA)、二维瓣环面积(2D-AA)、瓣环面积变化分数(AAc)、瓣环圆形指数(SI)、瓣环收缩期位移(AsE)、幕状区高度(TH)、幕状区容积(TV)]进行组间对比分析,用Spearman相关性分析评估3D-AA与右心房、右心室容积的相关性,采用多元线性回归分析评估FTR严重程度的影响因素。结果:在年龄、RAVmax和RAVmin,重度FTR组大于其他各组,中度FTR组大于轻度FTR组及对照组,差异均有统计学意义(P均<0.05)。与对照组相比,轻度、中度、重度FTR组3D-AA、2D-AA增大,AsE、TH减低,中度、重度FTP组AP、TV增大,重度FTP组SI增大;与轻度FTR组相比,中度、重度FTP组3D-AA、2D-AA、AP、TV增大,重度FTP组SI增大;与中度FTP组相比,重度FTP组3D-AA、2D-AA、AP、TV、SI增大;以上差异均有统计学意义(P均<0.05)。3D-AA与右心房容积的相关性比其与右心室容积的相关性更强(P<0.001)。多因素线性回归分析显示,RAVmin、3D-AA与FTR严重程度独立相关(P均<0.001)。结论:心房颤动合并FTR患者的右心形态结构改变不同于经典FTR患者,RAVmin、3D-AA是其FTR严重程度的独立影响因素。Objectives:To assess the morphological changes of the right heart in patients with atrial fibrillation and functional tricuspid regurgitation(FTR)by real-time three-dimensional(3D)echocardiography.Methods:A total of 80 FTR patients with persistent atrial fibrillation,who were hospitalized in Guangdong Second Provincial General Hospital from October 2021 to November 2022,were enrolled in this study and were divided into three groups:mild(the width of the tricuspid regurgitation vena contracta[VCW]<3.0 mm,n=30),moderate(VCW 3.0-3.9 mm,n=30),and severe(VCW≥7.0 mm,n=20)FTR Thirty-three patients with sinus rhythm who had no history of cardiovascular or pulmonary disease were enrolled as control group.Data derived from 3D echocardiography measurements were analyzed offline in EchoPAC 204 workstation.The obtained data included right atrial maximum volume(RAVmax),right atrial minimum volume(RAVmin),right ventricular end-diastolic volume index(RVEDVI),right ventricular ejection fraction(RVEF),left ventricular end-diastolic volume index(LVEDVI),left ventricular ejection fraction(LVEF)and tricuspid valve parameters(annulus circumference[AP],three-dimensional annulus area[3D-AA],two-dimensional annulus area[2D-AA],fraction of annulus area change[AAc],annulus circularity index[SI],annulus systolic displacement[AsE],tentacular height[TH]and tentacular volume[TV]).Correlations between 3D-AA and right atrial and right ventricular volume were tested using Spearman analysis.The determinants of FTR severity were analyzed by multivariate linear regression.Results:The age of severe FTR group was older than that of mild,moderate FTR and control group,while the age of moderate FTR group was older than that of mild FTR and control group(all P<0.05).RAVmax and RAVmin were larger in severe FTR group than in other three groups,which were larger in moderate FTR group than in mild FTR group and the control group,which were larger in mild FTR group than in control group(all P<0.05).Compared with the control group,the 3D-AA and 2D-AA increas

关 键 词：超声心动描记术 实时三维 功能性三尖瓣反流 心房颤动 三尖瓣瓣环 

分 类 号：R54[医药卫生—心血管疾病]