斑点追踪成像技术评价类风湿性关节炎患者右室收缩功能

摘要

目的 探讨斑点追踪成像(STI)技术评价类风湿性关节炎(RA)患者右室收缩功能的临床价值.方法 选取66例RA患者和30例健康体检者(对照组)接受超声心动图检查,根据RA患者的三尖瓣反流峰值速度和右房压力估测肺动脉收缩压是否>35 mm Hg(1 mm Hg=0.133 kPa),分为肺动脉高压组(PAH组)29例和非PAH组35例.采集心尖三腔心、四腔心及胸骨旁右心两腔切面的二维动态图像,应用二维应变分析软件获得右室侧壁、前壁、后壁及室间隔的纵向应变,并计算右室整体纵向应变(RVGLS).通过三尖瓣反流峰值估测肺动脉收缩压;常规超声心动图测量并计算右室面积变化分数(RVFAC);应用组织多普勒成像技术测量三尖瓣环收缩期峰值速度(TAPSPV)和三尖瓣环收缩期位移(TAPSE),比较上述各组间参数的差异.结果 PAH组TAPSPV和TAPSE分别为(13.14±3.95)cm/s、(15.97±4.19)cm,均明显低于对照组[(15.67±3.99)cm/s、(19.03±4.51)cm]和非PAH组[(15.97±3.84)cm/s、(18.14±4.16)cm],差异均有统计学意义(均P<0.05);非PAH组TAPSPV和TAPSE与对照组比较,差异均无统计学意义.PAH组RVGLS绝对值为(16.11±3.84)%,较对照组(20.83±4.48)%和非PAH组(18.47±4.16)%均减低,差异均有统计学意义(均P<0.05),非PAH组RVGLS绝对值较对照组亦明显减低,差异有统计学意义(P<0.05).RA患者的RVGLS与肺动脉收缩压呈正相关(r=0.532,P<0.01).结论 RA患者右室收缩功能较正常成人降低,尤其是继发PAH的RA患者降低更为明显,其右室收缩功能随肺动脉压力增高而降低.应用STI技术测量RVGLS对评估RA患者右室收缩功能有重要的临床价值.%Objective To evaluate the clinical value of right ventricular systolic function in patients with rheumatoid arthritis(RA) by speckle tracking imaging(STI).Methods Sixty-four patients with RA and 30 healthy subjects(control group) received echocardiography examination.According to the pulmonary pressure whether more than 35 mm Hg(1 mm Hg=0.133 kPa) or not,the patients with RA were divided into 29 patients with secondary pulmonary hypertension(PAH group) and 35 patients without PAH(non-PAH group).Acquiring dynamic two-dimensional images of apical 3-chamber view,four chamber view and parasternal right ventricular two-chamber views.The two-dimensional strain analysis software was used to calculate the global longitudinal strain of right ventricular lateral,anterior and posterior walls and ventricular septum,and the overall longitudinal strain of right ventricle(RVGLS).The peak velocity of tricuspid regurgitation was used to estimate pulmonary artery systolic pressure.The right ventricular fractional area change(RVFAC) was measured.Tissue Doppler imaging was used to measure tricuspid annular plane systolic peak velocity(TAPSPV) and tricuspid annular plane systolic excursion(TAPSE).Results The TAPSPV and TAPSE in PAH group[(13.14±3.95)cm/s and(15.97±4.19)cm] were reduced significantly compared with the control group[(15.67±3.99)cm/s and(19.03±4.51)cm] and non-PAH group[(15.97±3.84)cm/s and(18.14±4.16)cm],there were significant difference(all P<0.05).The TAPSPV and TAPSE were not different between the non-PAH group and control group.The absolute values of RVGLS was obviously lower in PAH group than that in the control group(16.11%±3.84%vs. 20.83%±4.48%,P<0.05),and also lower than that in non-PAH group(16.11%±3.84% vs. 18.47%±4.16%,P<0.05).Non-PAH group had significantly lower RVGLS (absolute values) than that in control group(18.47%±4.16%vs. 20.83%±4.48%,P<0.05).The RVGLS was positively correlated to pulmonary artery systolic pressure in patients with RA(r=0.532,P<0.01).Conclusion Right ventricular systolic function is reduced in patients with RA,especially in RA patients with secondary pulmonary hypertension.Right ventricular systolic function is worse in the RA patients with higher pulmonary arterial pressure.RVGLS measured by STI is a sensitive method for evaluating right ventricular systolic function in patients with RA.