组织多普勒右室Tei指数评价肺动脉高压患者右心室功能

摘要

目的 运用组织多普勒成像技术(tissue Doppler imaging,TDI)测算肺动脉高压患者右心室Tei指数,探讨其在评价不同程度肺动脉高压患者右室功能的临床应用价值以及获取右室Tei指数的合理观测点.方法 入选研究对象为正常对照组和肺动脉高压组,并依肺动脉压力升高的程度将肺动脉高压组分为轻、中、重度3个亚组.组织多普勒分别在心尖四腔切面三尖瓣前瓣附着处、隔瓣附着处及胸骨旁右心两腔切面后瓣附着处记录三尖瓣环运动频谱并测算右室Tei指数.结果 (1)肺动脉高压患者右室Tei指数较正常对照组增高(P<0.05);(2)三尖瓣前瓣附着处取样点所测右室Tei指数在轻、中、重度肺动脉高压组间均有明显差异,且Tei指数与肺动脉压力呈正相关(r=0.75,P<0.05);(3)隔瓣及后瓣附着处取样点所测Tei指数轻、中度组间无显著性差异,重度组较轻、中度组增高(P<0.05).结论 肺动脉高压患者右心室Tei指数升高,提示右心室整体功能降低,且与肺动脉收缩压呈正相关.TDI测量右室Tei指数可较准确反映右室整体功能,为临床评估肺动脉高压患者右心功能提供了一种无创的、新的检测方法.心尖四腔切面右室侧壁三尖瓣前叶瓣环处测定右室Tei指数是较为理想的测定点.%Objective To explore the change of right ventricular function in patients with pulmonary hypertension(PH) by Tei index obtained from tissue Doppler imaging (TDI)and to compare and choose the reasonable site for measuring Tei index of right ventricle.Methods 86 patients with pulmonary hypertension and 32 controls were studied and the patients were divided into 3 groups according to the level of pulmonary hypertension.Tei index of right ventricle was obtained by TDI from three points separately:the anterior tricuspid and septal tricuspid annulus in the apical four chamber view and the posterior annulus of parasternal right heart two chamber view.Results (1) Tei index of right ventricle in patients with pulmonary hypertension was higher than that of the control group significantly P<0.05).(2) Tei index of right ventricle obtained from the anterior tricuspid annulus was significantly different in mild，moderate and severe PH groups，respectively.A better correlation was observed between Tei index of right ventricle and PASP (r=0.75，P<0.01).However，there was significant difference of Tei index measured at septal tricuspid and posterior tricuspid annulus only in severe PH group compared with mild and moderate PH groups.Conclusions Tei index of right ventricle significantly increased in PH patients and was positively correlated with pulmonary artery systolic pressure.The anterior tricuspid annulus in apical four chamber view is a reasonable site for measuring Tei index of right ventricle by TDI compared with the septal and posterior tricuspid annulus.