| Background and PurposePatients with Acute Heart failure(AHF)have a high mortality rate upon admission,and it is not clear how best to monitor changes in their condition.Right ventricular systolic dysfunction is considered to be a factor in poor prognosis in patients with heart failure.The purpose of this study was to evaluate the structural,functional and hemodynamic changes of the right heart and its correlation with the function of the left heart in AHF patients with reduced ejection fraction before and after treatment by routine transthoracic echocardiography and two-dimensional speckle tracking technology.MethodsThirty-three patients with acute heart failure with decreased ejection fraction(Hr EF)who were admitted to the department of cardiology,the first affiliated hospital of Harbin medical university from October 2019 to mid-january 2020 were selected.Among them,there were 23 males and 10 females,with an average age of 59.42 ±13.58 years old.General information and medical history were collected for the enrolled patients,and medication status,pre-treatment and post-treatment NT-pro BNP assay values were recorded.Before and after treatment,routine echocardiographic examination and two-dimensional spot tracking technique were performed to analyze the myocardial strain.Analyze the changes of NT-pro BNP,clinical symptoms and echocardiographic indexes,and explore the correlation between right ventricular function and left heart function and clinical symptoms after treatment.ResultsAfter treatment,the NYHA grading evaluation of cardiac function of the patients was better than before,the degree of edema and degree of dyspnea were improved,and the level of NT-pro BNP was decreased compared with before,the difference was statistically significant(P < 0.001).2)After treatment,the echocardiographic indexes of IVSD,LVPWd,LVIDd,LAD,right ventricular wall thickness showed no significant changes compared with those before treatment(P>0.05).After treatment,e’,E /e’,the global longitudinal strain of the left ventricle,the upper and lower diameter of the right atrium,the transverse diameter of the right ventricle,FAC,s’,TAPSE,PASP,the longitudinal strain of the RV free wall and the global longitudinal strain of the RV at the LVEF and ventricular septum were all improved,and the differences were statistically significant(P<0.05).3)Dyspnea before treatment was positively correlated with E/e’,the global longitudinal strain of RV,and the longitudinal strain of RV free wall,with statistically significant differences(P<0.05),with statistically significant differences(P<0.05).The degree of edema was positively correlated with the global longitudinal strain of LV,the global longitudinal strain of RV and the longitudinal strain of RV free wall,and the difference was statistically significant(P<0.05).The degree of edema was negatively correlated with s’,and the difference was statistically significant(P<0.05).Before treatment,the level of NT-pro BNP was positively correlated with the global longitudinal strain of the left ventricle,the global longitudinal strain of RV and the longitudinal strain of RV free wall,and the difference was statistically significant(P<0.05).4)After treatment,the degree of edema was negatively correlated with LVEF,and the difference was statistically significant(P<0.05).After treatment,the level of NT-pro BNP was positively correlated with E/ E ’,the global longitudinal strain of the left ventricle,and the global longitudinal strain of the RV(P<0.05).5)The longitudinal strain of RV free wall after treatment was positively correlated with the global longitudinal strain of the left ventricle after treatment,and the difference was statistically significant(P=0.001).The global longitudinal strain of RV after treatment was positively correlated with the global longitudinal strain of left ventricle after treatment,and the difference was statistically significant(P<0.001).ConclusionsIn the treatment of patients with acute HFr EF,the echocardiography indexes to evaluate the right heart function were all improved compared with the previous ones.Compared with the conventional echocardiography indexes to evaluate the right heart function,the RV strain measured by Two-dimensional Speckle tracking technology was correlated with the patient’s dyspnea,edema degree and NT-pro BNP level.RV free wall strain and RV global longitudinal strain should be positively correlated with LV global longitudinal strain.RV strain can be used as a sensitive echocardiography index in the diagnosis and treatment of AHF patients. |
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