| Background:Pulmonary hypertension(PH)is a persistent pulmonary circulation resistance rise caused by primary or secondary,and then lead to pulmonary artery systolic pressure(PASP)continued to rise,damage the right heart function,or even death related diseases,if clinical not interfere with its rapid development,the prognosis is poor.Right atrium,as an integral part of the right ventricular system,not only plays an important role in maintaining the right ventricular perfusion,but also plays an important role in maintaining the right ventricular function.Traditional echocardiography is often used as an evaluation tool for right atrial structural function,and has been widely used in clinical practice.It is mainly used to measure the right atrium diameter and volume in two-dimensional plane,and to evaluate the overall function of the right atrium,however traditional echocardiography has certain limitations,such as:the assessment of ventricular wall motion state using the visual method and semi quantitative method,the evaluation results often lead to subjective increased and objectivity fall,the poor reproducibility of measurement data,the results of credibility decline.Therefore,the existence of the limitations limit the application of traditional echocardiography in the assessment of cardiac function in certain extent.With the development of ultrasonic technology,speckle tracking echocardiography(STE)as a new method to evaluate heart function,can well overcome the limitations of the traditional echocardiography,accurately and rapidly evaluate myocardial function.STE can not only reflect the local deformation model of complex myocardial motion,and no angular dependence,without towing effect,its the time resolution and spatial resolution is far superior to the traditional echocardiography,makes the measurement results more objective and accurate and cause clinical attention.In this study,we use STE for the quantitative analysis of the strain ability of right atrial myocardium in patients with PH,and combined with three-dimensional echocardiography(3DE)for the quantitative analysis of the volume function of right atrium in patients with PH,and to explore the correlation between STE strain parameters and 3DE volume function parameters of right atrium.Expected to open up a new way to evaluate right atrial function in patients with PH.Objective:To use STE for the quantitative analysis of the strain ability of right atrialmyocardium in patients with PH］ and combined with 3DE for the quantitative analysis of the volume function of right atrium in patients with PH］ and to explore the correlation between STE strain parameters and 3DE volume function parameters of right atrium.Methods:Selected a total of 63 patients with PH as the research object of this study,from march 2015 to august 2016,in the hospital outpatient or inpatient.According to the different levels of PASP,divided into group B(PASP=30～49mmHg)21 cases;group C(PASP=50～69 mmHg)21 cases;group D(PASP>70 mmHg)in 21 cases.Exclusion criteria:Organic left heart disease,severe three tricuspid regurgitation,right ventricular outflow tract stenosis,pulmonary stenosis,severe arrhythmias,congenital heart disease,pericardial effusion and ultrasound image not clear.A total of 21 healthy subjects as the control group(group A,PASP<30 mmHg)from physical examination center in this study.All the subjects signed the informed consent.The Vivid E9 GE ultrasound diagnostic instrument was used to all the study subjects in accordance with the criteria,and the traditional echocardiography,STE and 3DE were performed.The longitudinal strain curves were obtained and recorded STE strain parameters:negative peak value of strain(LS-n,unit%),positive peak value of strain(LS-p,unit%),total value of longitudinal strain(LS-t,unit%).By the right atrial volume-time curve,measured and recorded 3DE volume function parameters:minimum volume of right atrium(V-min,unit ml),volume before contraction,(V-pre,unit ml),maximum volume of right atrium(V-max,unit ml),emptying fraction of right atrium(EF,unit%),total stroke volume,(SV,unit ml),active emptying fraction of right atrium(EF-act,unit%),passive stroke volume of right atrium9(SV-pas,unit ml),active stroke volume of right atrium(SV-act,unit ml),passive emptying fraction of right atrium(EF-pas,unit%).After correction,the 3DE volume function parameters were obtained and recorded corresponding volume function index:SVI,EFI,SVI-pas,-pas EFI,SVI-act,-act,VI-max,VI-pre,EFI and VI-min.A comparative analysis of the STE strain and 3DE volume parameters in the right atrium.Combined with clinical data,Using ROC curve to obtain the cut-off value of STE parameters for predicting the right atrial myocardial dysfunction in patients with PH.Results:1.LS-n in Group B higher than that in group A(<0.05 P),with the increase of PASP,LS-n in patients with PH decreased gradually,LS-n in Group B>LS-n in Group C>LS-n in Group D(P all<0.05);With the increase of PASP,the LS-p and LS-t in each group decreased gradually,LS-p and LS-t in group A>LS-p and LS-t in group B>LS-p and LS-t in group C>LS-p and LS-t in group D(P all<0.05).2.With the increase of PASP,VI-max,VI-pre and VI-min in each group increased gradually:VI-max,VI-pre and VI-min in group A<VI-max,VI-pre and VI-min in group B<VI-max,VI-pre and VI-min in group C<VI-max,VI-pre and VI-min in group D(P all<0.05).3.With the increase of PASP,SVI between the groups was increased first and then decreased,SVI in group B,group C and group D were significantly higher than those in group A,SVI in group C and group D were significantly higher than those of group B(P all<0.05),there was no significant difference between C group and D group(P>0.05).There was no significant difference in SVI-pas between the groups(P>0.05).With the increase of PASP,SVI-act between the groups was increased first and then decreased,SVI-act in group B,group C and group D were significantly higher than those in group A,SVI-act in C group and D group were significantly higher than those in group B(P all<0.05),there was no significant difference between C group and group D(P>0.05).4.With the increase of PASP,EFI and EFI-pas in each group decreased gradually:EFI and EFI-pas in group A>EFI and EFI-pas in group B>EFI and EFI-pas in group C>EFI and EFI-pas in group D(P all<0.05).With the increase of PASP,the EFI-act in each group increased first and then decreased,EFI-act in group B and group C were significantly higher than that in group A(P<0.05),EFI-act in group D were significantly lower than that in group B,group C(P all<0.05),EFI-act in group D and group A were not statistically significant(P>0.05).5.LS-n was positively correlated with EFI(r=0.78,P=0.00,P<0.05);LS-p was positively correlated with EFI(r=0.76,P=0.00,P<0.05);LS-t was positively correlated with EFI(r=0.87,P=0.00,P<0.05),the correlation between LS-t and EFI was the most significant.6.It has higher clinical application value using the LS-t to predict atrial myocardial dysfunction in patients with PH:the area under the curve(AUC)=0.87(95%CI= 0.732-0.991),the best cut-off value was 32.68(%),sensitivity and specificity were 84.37%,86.65%respectively.Conclusion:STE can provide a new method for further study of right atrial function,provide the objective reference for disease diagnosis,treatment,curative effect evaluation and prognosis decision in patients with PH. |
PDF Full Text Request