Two-dimensional Speckle-tracking Imaging Estimates Right Ventricular Systolic Function In Patients With Chronic Obstructive Pulmonary Disease

Objectives1.To identify right ventricular systolic global longitudinal strain and regional strain in patients with chronic obstructive pulmonary disease(COPD)by using of two-dimensional speckle-tracking imaging,in order to explore the variety of right ventricular global myocardial systolic function and regional myocardial systolic functions in patients with COPD at different stages and evaluate the effects of pulmonary artery systolic pressure on right ventricular systolic function.So as to provide evidences for judging the condition and tailored treatment.2.The tricuspid annular plane systolic excursion(TAPSE),right ventricular fractional area change(FAC)and right ventricular index of myocardial performance(RIMP)were measured in patients with COPD by using m-mode ultrasound,two-dimension and tissue doppler ultrasound.The correlation between right ventricular systolic global longitudinal strain and the above three parameters was generated by correlation analysis,respectively.Materials and Methods1.Sixty patients with COPD and thirty healthy controls were eligible for our study.Patients with COPD were divided into NPH group and PH group according to the measurements of pulmonary artery systolic pressure,with thirty patients in the NPH group and thirty patients in the PH group.NPH group was defined as PASP<35mmHg,while PH group was defined as PASP?35mmHg.Pulmonary artery systolic pressure(PASP)was estimated by the peak velocity of the tricuspid regurgitation and right atrial pressure(RAP).PASP=4VTR~2+RAP.In the two-dimensional mode,right ventricular fractional area change was measured,tricuspid annular plane systolic excursion(TAPSE)was measured by m-mode ultrasound,and right ventricular index of myocardial performance was evaluated by tissue doppler method,respectively.2.Philips IE-33 Ultrasonic diagnostic instrument with adult transthoracic probe(frequency 1~5MHZ)and QLAB8.1 quantitative analysis software was adopted in the study.Myocardial longitudinal peak systolic strain was determined at the basal,mid and apical segment of the right ventricular free wall and ventricular septum by using of QLAB8.1 software for the above three groups,respectively.Right ventricular global longitudinal peak systolic strain was also obtained simultaneously.The parameters were compared between every two groups in the above groups.In addition,the correlation was analyzed between GLS and FAC,TAPSE,RIMP,respectively.Results1 Comparison of right ventricular systolic function parameters1.1Compared to control group:RIMP in NPH group was higher than that in control group,the difference was statistically significant,P<0.05.1.2 Compared to the control group:The two groups were significantly different(P<0.05)in RVFW,RVED,RIMP,FAC and TAPSE,PH group were higher than control group in RVFW,RVED and RIMP,while PH group were lower than control group in FAC and TAPSE.1.3 PH group and NPH group:RVFW?RVED?RIMP in PH group were higher than those in NPH group,while FAC in PH group was lower than that in NPH group,the differences were statistically significant,P<0.05.2 Comparison of right ventricular longitudinal strain parameters2.1 Compared to control group:The two groups were significantly different(P<0.05)in GLS?BAL-S?MAL-S?APL-S?BIS-S and MIS-S,NPH group were lower than control group.2.2 Compared to control group:The two groups were significantly different(P<0.05)in GLS?BAL-S?MAL-S?APL-S?BIS-S?MIS-S and APS-S,PH group were lower than control group.2.3 PH group and NPH group:GLS?BAL-S in PH group were lower than those in NPH group,the differences between the two groups were statistically significant,P<0.05.3.The correlation coefficients between right ventricular GLS and FAC?TAPSE?RIMP were 0.541,0.711,-0.532,p<0.01.Conclusion1.Right ventricular global and regional systolic function in patients with chronic obstructive pulmonary disease can be evaluated effectively and quantitatively by right ventricular systolic global longitudinal strain and regional strain which can be measured with two-dimension speckle-tracking imaging.2.With the increasing of pulmonary artery systolic pressure,the right ventricular systolic function is damaged more seriously and the free wall is the main wall.Longitudinal peak systolic strain at the basal of free wall can reflect the damage degree of Right ventricular systolic function.3.There is a certain correlation between right ventricular GLS and FAC,TAPSE and RIMP.The correlation coefficients between right ventricular GLS and TAPSE is highest.Right ventricular GLS can be applied as a reliable index for evaluating right ventricular global systolic and function quantitatively.