三维斑点追踪显像评价膜周部室间隔缺损患者右心室心肌收缩功能改变的研究  

Evaluation of Right Ventricular Myocardial Systolic Function in Patients with Peri-Membranous Ventricular Septal Defect by Three-Dimensional Speckle Tracking Imaging

作　　者：鲁瀚阳 易霞 周桦[1] LuHanyang;Yi Xia;Zhou Hua(Department of Ultrasound,Taihe Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]湖北医药学院附属太和医院超声医学科,湖北省十堰市442000

出　　处：《中国超声医学杂志》2024年第6期664-668,共5页Chinese Journal of Ultrasound in Medicine

基　　金：湖北省卫生健康委科研项目(No.WJ2023F087)。

摘　　要：目的 应用三维斑点追踪显像(3D-STI)评价膜周部室间隔缺损(VSD)患者右心室心肌收缩功能的改变。方法 VSD患者30例,正常对照组30例,记录年龄、心率、体表面积(BSA),袖带法测量静息状态下肱动脉收缩压,测3次取平均值。采用心尖四腔心切面测量右心室收缩末期横径(RVESD)、右心室舒张末期横径(RVEDD)、右心室搏出量(RVSV)、右心室面积变化率(RVFAC)。M型超声测量三尖瓣环收缩期位移(TAPSE);组织多普勒超声计算Tei指数及三尖瓣环收缩期最大峰值速度(TASPV);连续多普勒超声测量室水平分流最大压差,以肱动脉收缩压作为左心室压,左心室压与室水平分流最大压差之差即为右心室压,等同于肺动脉收缩压(PASP)。3D-STI得出右心室射血分数(RVEF)、右心室收缩末期容积指数(RVESVi)、右心室舒张末期容积指数(RVEDVi)、右心室整体主应变(RVGPS)、右心室整体横向应变(RVGCS)、右心室整体纵向应变(RVGLS)、右心室室间隔纵向应变(RVLS-Sep)、右心室游离壁纵向应变(RVLS-Fw),对结果进行组间比较。常规数据与三维应变指标行相关性分析,绘制RVLS-Fw及RVGPS的受试者工作特征(ROC)曲线。结果 (1)与对照组相比,VSD组PASP升高、Tei指数增高、TAPSE降低、RVFAC减少、RVEF降低、TASPV减低(P<0.05);(2)与对照组相比,VSD组RVLS-Fw、RVGPS降低(P<0.05);(3)PASP是影响VSD患者RVLS-Fw和RVGPS的决定因素(r值分别为-0.560、-0.666,P<0.05);(4)ROC曲线显示RVLS-Fw、RVGPS的曲线下面积分别为0.784、0.821。结论 膜周部VSD患者右心室心肌收缩功能降低,且与肺动脉收缩压呈中度负相关;右心室游离壁纵向应变及右心室整体主应变均可早期评估右心室心肌收缩功能改变,3D-STI是评价膜周部VSD患者右心室心肌功能改变的一种行之有效的新方法。Objective To evaluate right ventricular myocardial systolic function in patients with peri-membranous ven-tricular septal defect(VSD)by three-dimensional speckle tracking imaging(3D-STI).Methods Thirty patients diagnosed as VSD and 30 subjects as the control were enrolled.We recorded routine parameters such as age,heart rate,and body surface area(BSA).Cuff blood pressure(BP)measurement was used to measure the brachial artery systolic pressure in a resting state,with 3 measurements taken to obtain the average value.The apical four chamber view was used to measure the right ventricular end systolic diameter(RVESD),end diastolic diameter(RVEDD),stroke volume(RVSV),and right ventricular area change rate(RVFAC).Tricuspid annular plane systolic displacement(TAPSE)was measured using M-mode ultra-sound.Tei index(Tei)and maximum tricuspid annular systolic peak velocity(TASPV)were calculated using tissue Doppler ultrasound.Continuous Doppler ultrasound was used to measure the maximum pressure gradient at the ventricular shunt lev-el,and brachial artery systolic pressure was used as the left ventricular pressure.The difference between left ventricular pres-sure and the maximum pressure difference at the ventricular shunt level was defined as right ventricular systolic pressure,which was equivalent to pulmonary artery systolic pressure(PASP).3D-STI was used to obtain right ventricular ejection frac-tion(RVEF),right ventricular end systolic volume index(RVESVi);end diastolic volume index(RVEDVi),global principal strain(RVGPS),global lateral strain(RVGCS),global longitudinal strain(RVGLS),septal longitudinal strain(RVLS Sep),and longitudinal strain of right ventricular free wall(RVLS-Fw).The inter-group difference was compared.Correlation analysis between conventional data and three-dimensional strain indicators was performed.Receiver operating characteristic(ROC)curves was drawn for RVLS-Fw and RVGPS.Results OCompared with the control group,the VSD group showed increased PASP and Tei index,reduced TAPSE,RVFAC,RVEF,and TASPV(P

关 键 词：三维斑点追踪显像 超声心动图 室间隔缺损 右心室功能 

分 类 号：R541.1[医药卫生—心血管疾病] R540.45[医药卫生—内科学]