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斑点追踪显像技术评价法舒地尔对肺动脉高压患者右室收缩功能的影响

于雪芳1,赵利辉2,杨振文1,周贵明3,贾莉莉4,黄灿亮1   

  1. 1. 天津医科大学总医院
    2. 天津医科大学附属肿瘤医院
    3. 天津医科大学总医院心内科
    4. 天津医大总医院心内科
  • 收稿日期:2011-09-06 修回日期:2011-10-31 出版日期:2012-02-15 发布日期:2012-02-15
  • 通讯作者: 于雪芳

The effect of fasudil to right ventricular systolic function assessed by Speckle Tracking Imaging in patients with Pulmonary Arterial Hypertension

  • Received:2011-09-06 Revised:2011-10-31 Published:2012-02-15 Online:2012-02-15
  • Contact: Xue-Fang YU

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摘要： 目的：应用斑点追踪显像（STI）技术定量分析肺动脉高压（PAH）患者右室游离壁及室间隔心肌收缩期峰值应变(S)和峰值应变率 (SR)，探讨法舒地尔治疗对PAH患者右室收缩功能的影响。方法：PAH组17例，临床确诊为PAH且具有右心功能不全临床表现，超声心动图测量肺动脉收缩压（PASP）＞35mmHg。对照组20例，为年龄、性别相匹配的健康体检者。常规二维超声测量右房左右径（RA）、右室左右径(RV)、主肺动脉内径(MPA)、右室壁厚度(RVWT)及右室射血分数（RVEF）。STI测量右室游离壁及室间隔基底段、中段收缩期峰值S、SR，比较上述参数在两组间有无差异；比较应用法舒地尔治疗前后PAH患者上述参数的变化。结果：1. 与对照组比较，PAH组RA、RV、MPA、RVWT均增大（P ＜0.01），RVEF减小（P ＜0.01），PAH组右室游离壁基底段、中段收缩期峰值S、SR及室间隔基底段、中段收缩期峰值S和室间隔基底段收缩期峰值SR均低于对照组（P＜0.01或P＜0.05）。2. PAH患者应用法舒地尔治疗两周后，PASP、RA、RV降低（P ＜0.01），RVEF比用药前增加（P ＜0.05），右室游离壁基底段、中段收缩期峰值S、SR及室间隔基底段、中段收缩期峰值S较治疗前增加（P ＜0.01或P ＜0.05）。结论 STI技术测量右室游离壁基底段、中段收缩期峰值S、SR，能敏感、准确地反映Rho激酶抑制剂法舒地尔治疗前后PAH患者右室心肌收缩功能的改变情况，是评价PAH患者药物治疗效果的新方法。

关键词: 斑点追踪显像技术, 肺动脉高压, 应变, 应变率, Rho激酶抑制剂, 法舒地尔

Abstract: Objective To quantitatively analyse the peak systolic strain(S) and peak strain rate(SR) of the right ventricular free wall and ventricular septum in patients with pulmonary arterial hypertension (PAH) using speckle tracking imaging(STI) and discuss the effect of Rho kinase inhibitor Fasudil to right ventricular systolic function in PAH patients. Methods The PAH group, consisted of 17 PAH patients, who were diagnosed by echocardiography(PASP ＞35mmHg). A gender and age-matched control group of 20 healthy volunteers were assessed with echocardiography. To measure the inner diameter of right atrium(RA),right ventricle(RV),main pulmonary artery(MPA),right ventricular wall thinkness(RVWT) and right ventricular ejection fraction (RVEF). Select high frame rate images recorded from the apical four-chamber view (frame rate≥60Hz), peak myocardial systolic strain(S), strain rate(SR) were measured respectively in basal and mid segments of the free wall of right ventricle and ventricular septum. 3. To compare the differences in above parameters between the PAH group and control group. To compare the differences in above parameters in patients before and after fasudil therapy. Results 1. Compared with the control group, RA,RV,MPA and RVWT in the PAH group were increased （P ＜0.01）, RVEF was reduced in the PAH group（P ＜0.01）. In PAH group,S of basal and mid segments of right ventricular free wall and basal, mid segments of septum were lower than those in control group（P <0.01）, SR of basal and mid segments of free wall and basal segment of septum were lower than those in control group（P <0.01 or P<0.05）.2. The patients who got treatment of Fasudil 60mg,bid,have a reduction in PASP, RA, RV（P ＜0.01）, and have improvement in RVEF（P ＜0.05）. S and SR of basal, mid segments of free wall were increased（P ＜0.01 or P ＜0.05）,S of basal, mid segments of septum were increased（P ＜0.05）.Conclusions S and SR of basal, mid segments of right ventricular free wall measured by STI can be used to evaluate the improvement of right ventricular systolic function after fasudil therapy sensitively and exactly. It is a beneficial addition of conventional parameters which are used to evaluate the systolic function of right ventricle.

Key words: speckle tracking imaging, pulmonary arterial hypertension, strain, strain rate, Rho-kinase inhibitor, Fasudil