目的 研究不同心功能级别冠心痛患者的右心结构及功能变化,了解冠心痛患者右心结构及功能的损害.以便早期发现右心功能不良.同时通过研究不同严重程度慢性阻塞性肺疾病(COPD)患者的右心功能指标,了解冠心痛患者与COPD患者右心功能损害之间的异同.方法 所有入选者分为冠心痛组、COPD组和正常对照组3组.根据冠心痛患者的美国纽约心脏病协会(NYHA)心功能分级将2008年12月至2010年2月住院临床诊断冠心痛心功能不全患者68例再分为心功能Ⅱ级组(n=32)和心功能Ⅲ级组(n=36).根据是否合并肺源性心脏病将同期住院的COPD患者86例分为COPD肺心病组(n=40)和COPD无肺心痛组(n=46).正常对照组为同期门诊健康体检人群50例.测量3组的肺动脉内径(PAD)、舒张期右心室内径(RVED)、右心室前壁厚度(RAWT)、左心室射血分数(LVEF)、左心室及右心室Tei指数及肺动脉压等指标,比较异同.结果 两组冠心病患者PAD、RVED及RAWT与正常时照组比较,差异均无统计学意义.右心室Tei指教心功能Ⅱ级组(0.62±0.19)及心功能Ⅲ级组(0.66±0.13)高于正常对照组(0.29±0.09)(P<0.05).心功能Ⅲ级组右心室Tei指数与心功能Ⅱ级组比较差异无统计学意义.冠心痛患者右心室Tei指教与LVEF呈负相关(P<0.05),与左心室Tei指数呈正相关(P<0.05).冠心痛心功能Ⅲ级组、心功能Ⅱ级组及正常时照组分别有23例,10例,6例患者出现三尖瓣反流,估测肺动脉压分别为(22.11±6.23)mmHg(1 mmHg=0.133 kPa),(23.24±5.21)mmHg,(22.56±2.78)mmHg.COPD肺心痛组及无肺心病组患者PAD,RVED,RAWT数值高于正常对照组,肺心痛组右心室Tei指数(0.86±0.18)高于无肺心病组(0.67±0.12),肺心痛组及无肺心病组COPD患者右心室Tei指数均高于正常对照组(0.29±0.09),差异均有统计学意义.冠心痛与COPD患者相比,COPD肺心痛组RVED、RAWT、PAD及右心室Tei指数均高于COPD无肺心痛组及冠心痛心功能Ⅱ、Ⅲ级组,差异有统计学意义;COPD无肺心病组及冠心痛心功能Ⅱ、Ⅲ级组3组之间比较差异无统计学意义.结论 冠心痛心功能不全(心功能Ⅱ、Ⅲ级)患者右心结构(PAD、RVED、RAWT)无明显变化.冠心痛心功能不全患者在左心功能不良的同时亦存在右心功能不良.右心室Tei指数可早期评价冠心病患者及COPD患者右心收缩及舒张功能.%Objective To investigate the effects of chronic heart dysfunction in patients with coronary heart disease(CHD) and with chronic obstructive pulmonary disease(COPD) on right ventricular function and structural changes,different cardiac function class CHD patients and the COPD patients with or without cot pulmonale were studied,and the differences were compared to find the dysfunction of right heart early.Methods According to the cardiac function(NYHA) ,68 CHD patients hospitalized in Dec.2008-Feb.2010 were divided to class Ⅱ group( n =32)and class Ⅲ group( n =36).86 COPD patients hospitalized at the same time were divided to cor pulmonale group( n =40) and without cor pulmonale group ( n = 46).50 normal volunteers served as control group.Pulmonary artery dimension(PAD), right ventricular end-diastolic dimension (RVED), right ventricular anterior wall thickness (RVAWT),left ventricular ejection fraction,left and right ventircular Tei index(L, R-Tei index) and pulmonary artery pressure(PAP) were measured and compared.Results PAD, RVED and RAWT between two CHD groups were similar to control group( P ＞0.05).The R-Tei indexes of cardiac function in class Ⅱ group(0.62±0.19) and class Ⅲ group(0.66 ±0.13) were higher than that of control group (0.29 ± 0.09)( P ＜ 0.05).The Tei index was not significantly different between the two CHD groups.The R-Tei index was significantly negative related to LVEF, and was significantly positive related to L-Tei index.There were 23, 10 and 6 subjects observed tricuspid valve reflux in CHD class Ⅲ group,class Ⅱ group and control group.Estimated PAP was (22.11 ± 6.23) mm Hg, (23.24 ± 5.21 )mmHg,(22.56± 2.78) mmHg.PAD, RVED and RAWT of COPD cor pulmonale group and without cor pulmonale group were significantly higher than those of the control group.The R-Tei indexes of COPD with cor pulmonale group (0.86±0.18) and without cor pulmonale group (0.67±0.12) were significantly higher than that of the control group (0.29±0.09).R-Tei index of COPD with cor pulmonale group was significantly hither than that of the COPD without eor pulmonale group.PAD, RVED, RAWT and R-Tei index of COPD with cor pulmonale group were significantly higher than those of the COPD without cor pulmonale group and two CHD groups.There was no significant difference between the COPD without cor pulmonale group and two CHD groups.Conclusion There were no significant change of RVED,RAWT,PAD in CHD patients (cardiac function class Ⅱ and Ⅲ ).Right heart failure was observed in CHD patients with left heart failure.R-Tei index can early evaluate the systolic and diastolic function of right ventricle in patients with CHD and in patients with COPD.
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