超声斑点追踪技术定量评价单纯性二尖瓣狭窄患者右室收缩功能

摘要

目的 应用二维斑点追踪技术(2D-STI)定量评价单纯性二尖瓣狭窄(MS)患者右室收缩功能,并探讨影响其应变能力的主要因素.方法 入选MS患者32例[分A、B两组:A组,尚未出现肺动脉高压(PH)或轻度PH;B组,中到重度PH]与20例正常者(对照组).应用STI从右室整体到室间隔、游离壁两部分再到6个节段分别测定纵向收缩期应变(S)、应变率(SR),并分析影响S、SR改变的主要因素.结果 (1)A组 右室整体S、游离壁基底段S、室间隔整体及其各节段S、SR较对照组降低(P＜0.05),而游离壁整体S、SR无明显变化.(2)B组 右室整体到各个节段S、SR均较对照组降低(P＜0.05).(3)B组Pearson相关分析表明右室整体到局部的应变指标和肺动脉收缩压(PASP)有良好相关性,其中右室整体S相关性最好(r=0.81,P＜0.01),且两者存在依存关系,线性回归方程为Y=-68.31+0.805X.结论 STI可敏感、客观地评价右室收缩功能；PH是MS患者右室收缩功能受损的重要因素.%Objective To evaluate right ventricular (RV) longitudinal function in mitral stenosis (MS) patients by two-dimensional speckle tracking imaging (2D-STI) and discuss the factor of the change of global and regional peak systolic strain (S) and strain rate (SR). Methods 32 cases with MS were studied divided into two groups, Group A of patients with no pulmonary artery hypertension (PH) or mild PH, Group B of patients with moderate PH. Meanwhile, the group of 20 healthy subjects was as a comparison. Longitudinal peak systolic S, SR of RV were recorded for overall and for basal, mid and apical segments measured by 2D-STI, and analysis the factor of the change of deformation indices by statistical methods. Results (1) Group A: S of global RV, free wall basal segment and S, SR of all septum segments were significantly lower than those in the control group (P<0. 05). (2) Group B: S, SR of global RV and its all segments were significantly lower than those in the control group (P<0. 05). (3) In Group B, relevant analysis revealed positive correlation between RV deformation indices and pulmonary artery systolic pressure (PASP), especially S of global RV (r=0. 81, P<0. 01). Moreover, there was dependency relation between the two and the linear regression equation was Y= - 68. 31 + 0. 805X. Conclusions STI can sensitively and objectively quantify the right ventricular systolic function. PH is a crucial factor causing the damage of RV systolic function.