【摘要】 目的观察阻塞性睡眠呼吸暂停综合征(OSA)患者右室心肌应变特点,探讨速度向量成像(VVI)技术和QLAB定量软件评价OSA患者右室收缩功能的价值及其临床意义。方法选取OSA患者45例,常规超声心动图检测右室收缩功能各参数;于心尖四腔心切面分别应用QLAB软件和VVI软件获取右室各节段心肌应变曲线,记录右室整体纵向收缩期应变(GLSRV-QLAB、GLSRV-VVI),比较各参数之间的关系;绘制受试者工作特征曲线图,计算GLSRV-QLAB、GLSRV-VVI预测右室收缩功能障碍的最佳临界值。结果 GLSRV-QLAB与三尖瓣瓣环收缩期位移(TAPSE)、右室面积变化率(RVFAC)均呈显著负相关(r=-0.868、-0.832,均P<0.01);GLSRV-VVI与TAPSE、RVFAC均呈显著负相关(r=-0.804、-0.716,均P<0.01)。GLSRV-QLAB与GLSRV-VVI呈显著正相关(r=0.833,P<0.01)。以RVFAC<35%判定右室收缩功能减低,GLSRV-QLAB预测右室功能障碍的最佳临界值为-19.852%(95%CI:0.735~0.951),曲线下面积为0.869,敏感性80.0%,特异性86.7%;GLSRV-VVI预测右室收缩功能障碍的最佳临界值为-19.99%(95%CI:0.711~0.938),曲线下面积0.849,敏感性73.3%,特异性86.7%。GLSRV-QLAB与GLSRV-VVI预测右室收缩功能障碍的曲线下面积比较差异无统计学意义(差值=0.020,95%CI:-0.0791~0.1190,P=0.693)。结论 VVI技术和QLAB定量软件可以准确评价OSA患者右室功能,为临床评价右室功能提供较好的检测方法。更多还原

【Abstract】 Objective To observe the right ventricular myocardial strain characteristics in patients with obstructive sleep apnea syndrome(OSA),and to explore their clinical value and significance of the QLAB and velocity vector imaging(VVI)in the right ventricular systolic function measurement in patients with OSA. Methods Forty-five patients with OSA were enrolled,the right ventricular myocardial strain curve at each segment was obtained in apex four-chamber view by QLAB and VVI software,the right ventricle overall longitudinal systolic strain(GLSRV-QLAB,GLSRV-VVI) was recorded. The correlation between the parameters was compared,the receiver-operating characteristic(ROC)curve was drawn,and the best cut-off point of GLSRV-QLAB and GLSRV-VVI in predicting the right ventricular dysfunction was calculated. Results GLSRV-QLAB and GLSRV-VVI showed a significant correlation with traditional echocardiography right ventricular systolic function parameters.GLSRV-QLAB and RVFAC were negative correlated(r=-0.832,P<0.01),GLSRV-QLAB and TAPSE were negative correlated(r=-0.868,P<0.01),GLSRV-VVI and RVFAC were negative correlated(r=-0.716,P<0.01),GLSRV-VVI and TAPSE were negative correlated(r=-0.804,P<0.01). GLSRV-QLAB and GLSRV-VVI were positive correlated(r =0.833,P <0.01). Taking RVFAC<35% as right ventricular systolic dysfunction,the best cut-off value of GLSRV-QLAB for the detection of right ventricular dysfunction was-19.852%(95%CI:0.735~0.951),area under ROC curre was 0.869,with a sensitivity of 80.0% and a specificity of86.7%. The best cut-off value of GLSRV-VVI for the detection of right ventricular dysfunction was-19.99%(95% CI:0.711 ~0.938),area under ROC curre was 0.849,with a sensitivity of 73.3% and a specificity of 86.7%.There was no significant difference in the comparison of area by the Hanley-Mc Neil method(difference =0.020,95% CI:-0.0791 ~0.1190,P =0.693).Conclusion VVI and QLAB can evaluate the right ventricular function in patients with OSA,and can provide a new reliable approach for the assessment of right ventricular function.更多还原