右心室等容收缩期心肌加速度与肺动脉压力的相关性研究

Correlation study of right ventricular peak myocardial acceleration during isovolumic contraction and pulmonary arterial systolic pressure

关键词:  超声心动图  肺动脉高压  等容收缩期心肌加速度

Key words:  [Key words]　echocardiography  pulmonary arterial hypertension  right ventricular peak myocardial acceleration during isovolumic contraction

摘要:

[摘要]　目的　研究右心室等容收缩期心肌加速度（IVA）与三尖瓣反流法估测的肺动脉收缩压（PASP）之间的相关性，并探讨该参数能否作为预测肺动脉高压（PAH）程度的指标。　方法　选取三尖瓣反流法确诊的PAH患者45例为观察组，其中轻度PAH患者17例，中重度PAH患者28例，另选36例健康成年人作为对照组。超声心动图测量3组的超声常用参数，右室壁舒张末期厚度(RVWd)、右心室舒张末期内径（RVEDD）、左心室舒张末期内径（LVEDD）、右室收缩末期面积（RVESA）、右室舒张末期面积（RVEDA）、三尖瓣反流峰流速（V）、三尖瓣环收缩期峰速度（IVV）和等容收缩期时间（AT），计算右室面积变化率（RVFCA）、PASP 和IVA，比较分析3组检查结果。并将RVEDD、RVFCA和IVA与PASP进行相关性分析。　结果　轻度和中重度PAH组患者的RVWd、RVEDD、RVESA、RVEDA和正常对照组相比均明显增大（P<0.05或P<0.01），LVEDD及IVA有所降低，差异均有显著性意义（P<0.05或P<0.01）。轻度PAH组和中重度PAH组间RVFCA差异无显著性意义（P>0.05），但与对照组相比差异均有显著性意义（P<0.01）。PAH组患者总体的IVA与PASP具有显著相关性（r=-0.701，P<0.01）；组内分析IVA仅在中重度PAH组才与PASP有显著相关性（r=-0.646，P<0.01）。　结论　IVA是评估肺动脉压力的一项可靠指标，为临床早期准确地定量分析PAH并指导诊治提供一种真正意义上的无创性方法。

Abstract:

[Abstract] Objective To investigate the correlation between right ventricular peak myocardial acceleration during isovolumic contraction (IVA) and pulmonary arterial systolic pressure (PASP). Methods Forty-five patients with pulmonary arterial hypertension (PAH) (mean age 57.8±14.6 years old, 22 males) and 36 normal controls (group 1: mean age 52.7±14.4 years old, 19 males) were investigated. Patients with PAH were divided into mild (group2:17 cases) and moderate-severe (group 3:28 cases) groups. The end-diastolic right ventricular wall thickness (RVWd), end-diastolic right ventricular dimension and area (RVEDD and RVEDA), end-systolic right ventricular area (RVESA) were measured by Vivid-7 echocardiography. Tricuspid regurgitation peak velocity (V) was measured at the apical four-chamber view, The PASP and right ventricular fractional area change (RVFCA) were calculated. IVA at the basal segment of right ventricular free wall were acquired in apical four-chamber view using Doppler tissue imaging. Additionally, the Pearson correlation between IVA and PASP was analyzed. Results Compared with control group, RVWd, RVEDD, RVESA and RVEDA in the group 2 and 3 increased significantly (P<0.05 or P<0.01). Compared with the control group, RVFCA and IVA decreased in the group 2 and group 3 (P<0.01).Among all the patients of PAH,positive correlation was detected between RVEDD and PASP(r=0.483,P<0.05),and negative correlation was detected between not only RVFCA and PASP (r=-0.505, P<0.01), but also IVA and PASP (r=-0.701, P<0.01). However, a significant correlation was detected between IVA and PASP only in the group with moderate-severe PAH (r=-0.646,P<0.01). Conclusion IVA is a reliable parameter for assessment of pulmonary artery pressure.