二维斑点追踪技术联合实时三维超声心动图评估心房颤动合并三尖瓣反流患者右房结构和功能的临床价值  

Clinical value of two-dimensional speckle tracking combined with real-time three-dimensional echocardiography in evaluating right atrial structure and function in atrial fibrillation patients with functional tricuspid regurgitation

作　　者：李心怡 聂淑婷 邵袁缘 胡文姝 谌典 张奥懿 周畅[1] LI Xinyi;NIE Shuting;SHAO Yuanyuan;HU Wenshu;SHEN Dian;ZHANG Aoyi;ZHOU Chang(Department of Ultrasound,Yichang Central People’s Hospital,the First College of Clinical Medical Science,Three Gorges University,Hubei 443003,China)

机构地区：[1]三峡大学第一临床医学院,宜昌市中心人民医院超声科,湖北省宜昌市443003

出　　处：《临床超声医学杂志》2024年第9期713-718,共6页Journal of Clinical Ultrasound in Medicine

基　　金：湖北省宜昌市医疗卫生项目(A16-301-12)。

摘　　要：目的应用二维斑点追踪技术(2D-STI)联合实时三维超声心动图(RT-3DE)评估心房颤动(AF)合并中、重度功能性三尖瓣反流(FTR)患者右房结构和功能,探讨其临床应用价值。方法选取于我院就诊的阵发性AF患者134例,其中AF合并轻度FTR者99例(A组),AF合并中、重度FTR者35例(B组),另选取同期健康体检者41例为对照组。比较各组常规超声心动图参数[左房前后径(LAD)、左室射血分数(LVEF)、右房左右径(RAD1)、右房上下径(RAD2)、三尖瓣瓣环直径(TVD)、三尖瓣瓣叶闭合高度(TVH)及肺动脉收缩压(PAH)]、2D-STI参数[右房储存期应变(RASr)、管道期应变(RAScd)及辅泵期应变(RASct)]和RT-3DE参数[右房最大容积指数(RAVImax)、最小容积指数(RAVImin)、收缩前容积指数(RAVIpre)、被动排空分数(pasEF)及主动排空分数(actEF)]的差异。采用Logistic回归分析筛选AF合并中、重度FTR的独立影响因素;绘制受试者工作特征(ROC)曲线分析各参数预测AF合并中、重度FTR的诊断效能。结果各组LAD、LVEF、RAD1、RAD2、TVD、TVH及PAH比较差异均有统计学意义(均P<0.001)。与对照组比较,A、B组LAD、RAD1、RAD2及TVD均增高,TVH均降低,差异均有统计学意义(均P<0.05);与A组比较,B组LAD、RAD1、RAD2、TVD及PAH均增高,LVEF及TVH均降低,差异均有统计学意义(均P<0.05)。各组RASr、RAScd、RASct、RAVImax、RAVImin、RAVIpre、pasEF及actEF比较差异均有统计学意义(均P<0.05)。与对照组比较,A、B组RAVImax、RAVImin及RAVIpre均增高,RASr、RAScd、RASct、pasEF及actEF均降低,差异均有统计学意义(均P<0.05);与A组比较,B组RAVImax、RAVImin及RAVIpre均增高,RASr、RAScd、RASct、pasEF及actEF均降低,差异均有统计学意义(均P<0.05)。Logistic回归分析显示,TVD、RASr及RAVImin均为AF合并中、重度FTR的独立影响因素(OR=1.169、0.798、1.423,均P<0.05)。ROC曲线分析显示,TVD、RASr、RAVImin及RASr联合RAVImin预测AF合并中、重度FTR的曲线Objective To evaluate the right atrial structure and function in atrial fibrillation(AF)patients with moderate to severe functional tricuspid regurgitation(FTR)by two-dimensional speckle tracking(2D-STI)combined with real-time three-dimensional ultrasound(RT-3DE),and to explore its clinical application value.Methods A total of 134 patients with paroxysmal AF from our hospital were selected,including 99 patients with mild FTR(group A),35 patients with moderate to severe FTR(group B),and 41 healthy individuals in the same period as the control group were selected.The conventional echocardiographic parameters[left atrial anteroposterior diameter(LAD),left ventricular ejection fraction(LVEF),right atrial transverse diameter(RAD1),right atrial longitudinal diameter(RAD2),tricuspid valve annulus diameter(TVD),tricuspid valve leaflet tethering height(TVH),and pulmonary artery systolic pressure(PAH)],2D-STI parameters[right atrial strain during reservoir phase(RASr),right atrial strain during conduit phase(RAScd),and right atrial strain during contractile phase(RASct)]and RT-3DE parameters[right atrial maximum volume index(RAVImax),right atrial minimum volume index(RAVImin),right atrial pre-systolic volume index(RAVIpre),passive emptying fraction(pasEF),and active emptying fraction(actEF)],were compared among the groups.Logistic regression analysis was applied to screen the independent influencing factors of moderate to severe FTR in AF patients.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of each parameter in predicting moderate to severe FTR in AF patients.Results There were significant differences in LAD,LVEF,RAD1,RAD2,TVD,TVH,and PAH among the groups(all P<0.05).Compared with control group,the LAD,RAD1,RAD2,and TVD were increased and the TVH was decreased in the group A and group B(all P<0.05).Compared with the group A,the LAD,RAD1,RAD2,TVD and PAH were increased,and LVEF and TVH were decreased in the group B(all P<0.05).There were significant differences in RASr,RAScd,RASc

关 键 词：超声心动描记术 三维 实时 斑点追踪 二维 心房颤动 三尖瓣反流 心房功能 右 

分 类 号：R540.45[医药卫生—心血管疾病]