【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。更多还原

【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 age52. 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.更多还原