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目的应用传统超声二维模式测量肺动脉高压(pulmonary arterial hypertension,PAH)患者右室面积变化率及射血分数,并分析其与右室收缩期应变能力之间的相关性。使用二维应变软件定量分析PAH患者右室收缩期应变能力,并探讨不同程度肺动脉高压对右室收缩期峰值应变(S)及峰值应变率(SR)的影响。方法 PAH组[肺动脉收缩压(PASP)≥35mm Hg]分为3个亚组:轻度组24例,PASP35～45mm Hg;中度组22例,PASP46～59mm Hg;重度组19例,PASP≥60mm Hg。应用二维应变软件测量PAH患者和对照组的右室游离壁及室间隔各节段心肌收缩期峰值S、SR,记录并比较基底段、中段及心尖段的收缩期峰值S、SR在PAH组与对照组间有无差异,比较轻、中及重度PAH组间各测值有无差异。结果对照组EF值和面积变化率均高于PAH组(P<0.01),对照组右心房、右心室小于肺动脉高压组(P<0.01)。肺动脉高压患者的右室收缩期峰值S、SR低于正常人(P<0.01),随肺动脉高压程度的加重,右室收缩期峰值S、SR下降程度加重。射血分数与游离壁中段、基底段S在对照组和PAH组均高度相关(r=-0.604,P<0.001),与室间隔中段、基底段S在PAH组中有相关性,与游离壁基底段SR在PAH组高度相关(r=-0.603,P<0.001)。结论射血分数与收缩期峰值S及SR具有相关性,二维应变成像技术可作为独立指标来定量评价PAH患者右室局部收缩功能,为定量评估右室心肌功能提供一种新的方法。
Objective To measure the change of right ventricular area and ejection fraction in patients with pulmonary arterial hypertension (PAH) by using traditional two-dimensional ultrasound and analyze the correlation between the right ventricular systolic strain capacity and right ventricular systolic pressure. The 2D strain software was used to quantitatively analyze the right ventricular systolic strain capacity in patients with PAH and to explore the effect of different degrees of pulmonary hypertension on peak systolic strain (S) and peak strain rate (SR). Methods PAH group (PASP≥35mm Hg) was divided into three subgroups: mild group (24 cases), PASP (35-45mm Hg), moderate group (22 cases), PASP46 ~ 59mm Hg 60mm Hg. The systolic peak S and SR of right ventricular free wall and interventricular septum in patients with PAH and control group were measured by two-dimensional strain software. The systolic peak S and SR of basal, middle and apical segments were recorded and compared in PAH group With or without any difference between the control group, the light, moderate and severe PAH groups, the differences between the various measurements. Results The changes of EF and area in the control group were higher than those in the PAH group (P <0.01). The right atrium and the right ventricle in the control group were smaller than those in the pulmonary hypertension group (P <0.01). The peak S and SR of right ventricular systolic phase in patients with pulmonary hypertension were lower than those in normal people (P <0.01). With the increase of pulmonary hypertension, the decreasing of S and SR of the peak of RV systolic phase were aggravating. The ejection fraction was positively correlated with the middle segment of the free wall and the basal segment S in the control group and the PAH group (r = -0.604, P <0.001). The ejection fraction was correlated with the interventricular septum in the PAH group, The basal segment SR was highly correlated with PAH (r = -0.603, P <0.001). Conclusions The correlation between ejection fraction and peak S and SR of systolic phase is correlated. Two-dimensional strain imaging technique can be used as an independent index to quantitatively evaluate the regional systolic function in patients with PAH. It provides a new method for the quantitative assessment of right ventricular myocardial function.