Evaluation Of Right Ventricular Regional Systolic Function By Two Dimensional Speckle Tracking Imaging In Patients With Acute Pulmonary Thromboembolism

Objective:To observe the change of the right ventricular(RV) myocardial strain and the time to peak strain (ST) before and after anticoagulant and thrombolytic therapy in patients with APTE, then discuss the clinical value of Two dimensional speckle tracking imaging(2D-STI). To observe the RV myocardial strain characteristics, then discuss the value of2D-STI in quantitative analysising the different levels of APTE.Methods:Thirty-four patients with APTE and30age-matched and gender-matched normal subjects(the control group) were examined using echocardiography. There into25patients with APTE underwent repeat echocardiography after17±8days’treatments.6-Segmental RV longitudinal peak systolic strain (PSS) and the time to peak strain (ST) were analyzed using speckle-tracking strain echocardiography. The mean (STM) and standard deviation(STSD) of6-Segmental ST were calculated.Results:①Compared with the controls, ENDO-PSS and EPI-PSS of6-segments were significantly impaired in patients with APTE(P<0.05).②ENDO-PSS of6-segments of right ventricular wall and interventricular septum are significantly higher than before treatment in APTE patients with after treatment(P＜0.05). The PSS of apical segment of right ventricular wall and interventricular septum were no significant difference between after treatment group and control group(P<0.05), PSS of other segments are significantly lower than of the control group(P<0.05).③EPI-PSS of6-segments of right ventricular wall and interventricular septum are significantly higher than before treatment, significantly lower than the control group in APTE patients with after treatment (P<0.05).④The ENDO-STSD and EPI-STSD are significantly higher than the control group in APTE patients with before and after treatment. The ENDO-STSD and EPI-STsd are significantly lower than before treatment group in APTE patients with after treatment(P<0.05).①Compared with the controls, ENDO-PSS and EPI-PSS of3-segments were significantly impaired in patients with massive and submassive APTE(P<0.05), the ENDO-PSS of mid segment and EPI-PSS of3-segments of RV lateral wall are significantly lower than the control group in patients with non-massive APTE(P<0.05).②The PSS of3-segments of RV lateral wall was the highest in patients with non-massive APTE and the lowest in patients with massive APTE. The ENDO-PSS and EPI-PSS of3-segments of RV lateral wall were no significant difference between after massive group and submassive group (P＞0.05); The PSS of basal and mid myocardium under ENDO(endocardium) and EPI(epicardial) in RV lateral wall and septum myocardium under ENDO are significantly lower than non-massive APTE in patients with massive APTE(P<0.05); The PSS of basal myocardium under ENDO and EPI and septum myocardium under ENDO are significantly lower than non-massive APTE in patients with sub-massive APTE(P<0.05).Conclusion:1. The PSS of6-segments of RV were decreased in patients with APTE, STSD were increased; After treatment, the PSS and STSD were returned, but were not returned to normal. Two-dimensional STI can objectively assess curative effect after treatment in patients with APTE.2. Massive and sub-massive APTE patients PSS of RV lateral wall were significantly impaired; non-massive APTE patients PSS of RV lateral wall some segment were decreased, the systolic function were slightly reduced,2D-STI can quantitatively assess RV regional systolic function in patients with APTE of different levels.