三维斑点追踪技术评价急性肺动脉栓塞患者的右心室收缩功能

江佩; 张平洋

doi:10.12125/j.chj.202203033

三维斑点追踪技术评价急性肺动脉栓塞患者的右心室收缩功能

江佩,
张平洋

Evaluation of right ventricular function by three-dimensional speckle tracking imaging in patients with acute pulmonary embolism

摘要

摘要:
目的探讨新的右室三维斑点追踪（3D-STI）技术在评价急性肺动脉栓塞（APE）患者右心室整体及各节段收缩功能的意义。
方法选择南京市第一医院确诊的16例急性肺动脉栓塞患者作为APE组，同时选择16例健康志愿者作为对照组。应用新的右室3D-STI技术测量并比较两组间的右室收缩末期容积(RVESV)、右室舒张末期容积（RVEDV）、右室射血分数（RVEF）、右室整体纵向应变（RVGLS）、右室整体环向应变（RVGCS），分析RVGLS与RVEF的相关性。根据右室的人体解剖学生理特点将右室心肌分为７个心肌节段：即流入道侧壁（inflow tract lateral wall，ITL）、流入道前壁（inflow tract in front wall，ITI）及流入道间隔壁（inflow tract septal wall，ITS），流出道游离壁（outflow tract free wall，OTF），流出道间隔壁（outflow tract septal wall，OTS），心尖游离壁（apex free wall，AF）及心尖间隔壁（apex septal wall，AS）。应用新的右室3D-STI技术测量并比较两组间右心室7节段心肌纵向及环向应变值。
结果两组间右心室整体功能比较，与对照组相比，APE组的RVEDV，RVESV数值增高，RVEF数值下降， RVGLS绝对值下降（均P<0.05），而RVGCS与对照组相比差异无统计学意义。两组间右心室7个节段心肌纵向及环向应变值比较：纵向心肌应变值中APE组除心尖间隔壁（AS）外，其余6个节段心肌纵向应变值绝对值较对照组显著减低 (P<0.05)。环向心肌应变值中APE组仅流入道侧壁（ITL）、流入道前壁（ITI）及流入道间隔壁（ITS）3个节段心肌应变值绝对值显著减低（P<0.05）。Pearson相关性的分析结果显示，对照组RVGLS与RVEF呈负相关（r=−0.58，P<0.05）；APE组RVGLS与RVEF呈负相关（r=−0.54，P<0.05）。
结论 APE患者的右心室收缩功能明显减低，新的右室3D-STI技术可以准确地评价右心室收缩功能。

Abstract:
AIM To assess the right ventricular function by three-dimensional speckle tracking imaging in patients with acute pulmonary embolism.
METHODS 16 patients with acute pulmonary embolism diagnosed in Nanjing First Hospital were selected as APE group and 16 healthy volunteers as control group. The new right ventricular 3D-STI technique was used to measure and compare the right ventricular end systolic volume (RVESV), right ventricular end diastolic volume (RVEDV), right ventricular ejection fraction (RVEF), right ventricular global longitudinal strain (RVGLS) and right ventricular global circumferential strain (RVGCS) between the two groups, and analyze the correlation between RVGLS and RVEF. According to the human anatomy of the right ventricle, the right ventricular myocardium is divided into seven myocardial segments, namely the inflow tract lateral wall (ITL), the inflow tract in front wall (ITI) and the inflow tract septal wall (ITS), the outflow tract free wall (OTF) and the outflow tract septal wall (OTS), Apex free wall (AF) and apex septal wall (AS). The new right ventricular 3d-sti technique was used to measure and compare the longitudinal and circumferential strains of 7 segments of right ventricle between the two groups.
RESULTS Compared with the control group, the RVEDV and RVESV of APE group increased, the RVEF decreased, and the absolute values of RVGLS decreased, all P<0.05, but there was no significant difference between RVGCS and the control group. Comparison of longitudinal and circumferential strain values of 7 segments of right ventricle between the two groups: among the longitudinal myocardial strain values, the absolute values of longitudinal strain values of 6 segments in APE group except apical septum (AS) were significantly lower than those in the control group (P<0.05). Among the circumferential myocardial strain values, the absolute values of myocardial strain values in APE group were significantly lower only in the lateral wall of inflow tract (ITL), anterior wall of inflow tract (ITI) and septal wall of inflow tract (ITS) (P<0.05). Pearson correlation analysis showed that there was a negative correlation between RVGLS and RVEF in the control group (r=−0.58, P<0.05); There was a negative correlation between RVGLS and RVEF in APE group (r=−0.54, P<0.05).
CONCLUSION The right ventricular systolic function of APE patients is significantly reduced and 3D-STI could be used to detect and evaluate the right ventricular function.

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