摘要
目的 应用超声二维斑点追踪技术测量肺动脉高压（PH）患者三尖瓣环位移,并与右室功能指标对比,探讨该技术评价PH右心功能改变的临床应用价值.方法 临床确诊及疑诊PH患者58例,根据超声估测肺动脉收缩压分为PH组与对照组.右心功能参数包括：三尖瓣环收缩期位移（TAPSE）、右室面积变化分数（FAC）、三尖瓣环收缩期峰值速度（s＆#39;）及右心做功指数（RIMP）.三尖瓣环位移参数包括：三尖瓣环右心室游离壁收缩期峰值位移（TMAD1）、三尖瓣环室间隔收缩期峰值位移（TMAD2）、三尖瓣环连线中点收缩期峰值位移（TMADm）以及右心室纵向缩短分数（TMADm％）.结果 ①两组患者TAPSE、RIMP、FAC及s ＆#39;比较差异有统计学意义（P＜0.01）;两组患者TMAD1比较差异有统计学意义（P＜0.05）,TMAD2、TMADm及TMADm％比较差异具有显著统计学意义（P＜0.01）.②ROC曲线下面积显示三尖瓣环组织位移参数对PH患者右心功能减低具有中等预测价值（P＜0.01）.③TMADm％以15.5％作为截断值,判定FAC＜ 35％的灵敏度81.8％,特异度72.0％;判定TAPSE＜17 mm的灵敏度84.4％,特异度73.1％;判定RIMP＞0.54的灵敏度85.7％,特异度70.3％;判定s＆#39;＜9.5 cm/s的灵敏度72.3％,特异度100％.结论 三尖瓣环组织位移参数能够预测PH患者右心功能减低,为临床治疗及预后判断提供一种新的诊断指标.
Objective To measure tricuspid annular displacement by two-dimensional speckle tracking echocardiography in pulmonary hypertension （PH） patients,and compare with the right ventricular function parameters,finally discuss the clinical application value of this technology in evaluating the right ventricular function in PH.Methods A total of 58 patients diagnosed or suspected diagnosed as PH were divided into PH group and control group according to pulmonary arterial systolic pressure measured by echocardiography.The right ventricular function parameters included：tricuspid annular plane systolic excursion （TAPSE）,right ventricular fractional area change （FAC）,tissue Doppler-derived tricuspid lateral annular systolic velocity （s＆#39;） and right ventricular index of myocardial performance （RIMP）.The parameters of tricuspid annular displacement included：the peak systolic tricuspid annular displacement at right ventricular free wall （TMAD1）,the peak systolic tricuspid annular displacement at interventricular septum （TMAD2）,the peak systolic tricuspid annular displacement at midpoint of tricuspid annulus （TMADm） and the right ventricular longitudinal shortening （TMADm%）.Results ① There were significant statistical differences between two groups in TAPSE,RIMP,FAC and s＆#39; （P 〈0.01）,TMAD1 （P〈0.05）,and TMAD2,TMADm and TMADm% （P 〈0.01）.② Area under ROC curve indicated that parameters of tricuspid annular displacement had moderate predictive value in predicting the decline of right ventricular function in PH patients （P 〈0.01）.③ Setting 15.5% as cut-off value for TMADm% to assessment FAC〈35 %,TAPSE〈17 mm,RIMP〉0.54 and s＆#39;〈9.5 cm/s,their sensitivities were 81.8%,84.4%,85.7% and 72.3% respectively,and their specificities were 72.0%,73.1%,70.3% and 100% respectively.Conclusions The tricuspid annular tissue displacement parameters can predict the decrease of right ventricular function in patients with PH,and provide a new diagnostic index for clinical treatment and prognosis.
出处
《中华超声影像学杂志》
CSCD
北大核心
2016年第5期369-373,共5页
Chinese Journal of Ultrasonography
基金
国家自然科学基金项目，北京市“215”高层次卫生技术人才学科骨干项目(2014-3-027)National Natural Science Foundation of China，Beijing Health System High Level Health Technology Personnel Discipline Backbone Project
关键词
超声心动描记术
肺动脉高压
三尖瓣环位移
心室功能
右
斑点追踪技术
Echocardiography
Pulmonary hypertension
Tissue motion annular displacement
Ventricular function,right
Speckle tracking imaging
