Evaluation Of Ventricular Function In Connective Tissue Disease Patients With Pulmonary Arterial Hypertention Using Three-dimensional Speckle Tracking Imaging

Objective: The aim of this study was to evaluate the left and right ventricular function using three-dimensional speckle-tracking imaging(3D-STI)for pulmonary artery hypertension(PAH)in connective tissue disease(CTD)patients,to further provide diagnostic,therapeutic and prognostic information in clinic.Methods: 83 CTD patients were included in this study as case group.And 20 healthy people were included as control group.Case group was divided into 3 stages according to the tricuspid regurgitation velocity(TRV): CTD patients not combined with PAH(CTD-NPAH group),CTD patients suspected with PAH(CTD-NPAHI group),CTD patients combined with definite PAH(CTD-NPAHII group).General data,clinical data and biochemical data were collected.Following parameters were acquired by conventional echocardiography and 3D-STI:1.Right ventricular function: right ventricular fractional area change(RVFAC),right ventricular wall thickness(RVWT),right atrium area(RAA),tricuspid annular plane systolic excursion(TAPSE),tricuspid regurgitation velocity(TRV),systolic pulmonary artery pressure(s PAP),tricuspid annulus velocity(Tricuspid e'),pulmonary vascular resistance(PVR),right ventricular end-diastolic volume index(RVEDVi),right ventricular ejection fraction(RVEF),right ventricular free wall global longitudinal strain(RV-LS-F).2.Left ventricular function: left Ventricular end-diastolic dimension(LVEDD),relative wall thickness(RWT),eccentricity index(EI),left atrium volume index(LAVi),mitral flow early and later diastolic velocity(Mitral E,Mitral A),septal and mitral annulus early diastolic velocity(Mitral e' and Septal e'),calculated Mitral E/A and Mitral E/e',three dimensional left ventricular end-diastolic volume index(LVEDVi),three dimensional left ventricular ejection fraction(LVEF),septal global longitudinal strain,radial strain(LS-Sept,RS-Sept),left ventricular free wall global longitudinal strain,radial strain(LV-LS-F,LV-RS-F).The differences in right ventricular function and left ventricular function between the four groups were compared.Pearson correlation coefficients was performed to test weather relative factors have an effect on ventricular function.Results:1.Right ventricular function:(1)Right ventricular diastolic function:The Tricuspid e' were significantly decreased compared with control group and CTD-NPAH group,and RAA increased in CTD-PAHII group patients compared with other three groups(P<0.05).(2)Right ventricular systolic function:The TAPSE and RVFAC were significantly decreased and RVWT increased in CTD-PAHII group patients compared with other three group(P<0.05).And the RVFAC of CTD-PAHI group were lower,RVWT were higher than control group and CTD-NPAH group(P<0.05).The RVEDVi of CTD-PAHII group were higher than other three groups(P<0.05).The RVEF,RV-LS-F decreased alone with the pulmonary artery systolic pressure increased(P<0.05).2.Left ventricular function:(1)Left ventricular diastolic function:The E/A,Mitral e',Septal e' were significantly decreased in CTD-PAHII group compared with other three groups(P<0.05).And the LAVi of CTD-PAHII group were lower than CTD-NPAH group and CTD-PAHI group(P<0.05).The LAVi of CTD-NPAH group and CTD-PAHI group were higher than control group(P<0.05).(2)Left ventricular systolic function:The LVEDD,LVEDVi of CTD-PAHII group were lower than other three groups(P<0.05).And RWT,EI of CTD-PAHII group were higher than other three groups(P<0.05).The LVEDVi of CTD-PAHI group were lower than control group and CTD-NPAH group.Compared with the control group,the LS-Sept and RS-Sept were increased in CTD group(P < 0.05).And increased alone with the pulmonary artery systolic pressure increased(P<0.05).The LV-LS-F and LV-RS-F were significantly increased in control group compared with CTD groups(P<0.05).3.Relative factors with ventricular function:The parameters of RV-LS-F showed a negative correlation with s PAP,PVR,WHO function class and RVWT.The parameters of LS-Sept,RS-Sept,LV-LS-F and LV-RS-F showed negative correlations with s PAP.The parameters of LS-Sept and RS-Sept showed negative correlations with PVR.The parameters of LS-Sept,RS-Sept and LV-LS-F showed negative correlations with WHO Function class.The parameters of LS-Sept and RS-Sept showed negative correlations with EI and RWT.The parameters of RV-LS-F,LS-Sept and RS-Sept showed negative correlations with BNP and uric acid.Conclusions:1.The diastolic and systolic function of right ventricular were decreased in CTD patients combined with PAH.3D-STI is a sensitive method in observing the damage of ventricular function.The right ventricular systolic function had a positive correlation with s PAP,PVR and myocardium compliance.2.The diastolic and systolic function of left ventricular were decreased in CTD patients combined with PAH,especially in interventricular septum.3.The ventricular systolic function was correlated with BNP and uric acid in CTD patients combined with PAH.4.Myocardial involvement in CTD patients without PAH may cause a reducion of left ventricular systolic function,especially in interventricular septum.