CAJ | 학술논문

目的探讨用三尖瓣环收缩期运动幅度(TAPSE)评价充血性心力衰竭患者预后的重要价值。方法研究对象为48例心功能 (NYHA)Ⅲ～Ⅳ级的充血性心力衰竭(CHF)患者和30例正常对照者。常规应用超声心动图测定各组的右室内径(RVDd)、右房面积(RAA)、右室面积(RVA)、右室游离壁厚度(RVFWT)、右室舒张及收缩末容积(RVEDV、RVESV)、右室每搏量(RVSV)及右室射血分数(RVEF)、TAPSE、二尖瓣舒张早期及晚期血流速度峰值(E峰、A峰)、E/A比值及E峰减速时间(EDT)。选择确定评价CHF预后的可靠指标。结果与对照组比较,CHF组的RVDd、RAA、RVA、RVEDV、RVESV、RVSV、A峰、E峰增大(P<0.01～0.001)；RVFWT、TAPSE、E/A、EDT及RVEF降低(P<0.01～0.001);TAPSE与RVEF及LVEF呈显著正相关(r=0.76 及r=0.78,P<0.001)。随访(20±11)个月期间，有12例发生心源性猝死(SCD)。经非变量分析确定RVDd>31 mm、TAPSE≤14 mm、LVEF<35%和EDT<120 ms可作为判断心功能NYHA Ⅲ～Ⅳ级的可靠指标(P<0.001),而多变量分析确定TAPSE和LVEF可作为SCD独立的预报因子。结论 TAPSE的测定不受心脏节律的影响，在所有CHF患者都容易获得，它不仅可反映心功能NYHA分级程度,而且对预后的评价具有重要的临床意义。
목적탐토용삼첨판배수축기운동폭도(TAPSE)평개충혈성심력쇠갈환자예후적중요개치。방법연구대상위48례심공능 (NYHA)Ⅲ～Ⅳ급적충혈성심력쇠갈(CHF)환자화30례정상대조자。상규응용초성심동도측정각조적우실내경(RVDd)、우방면적(RAA)、우실면적(RVA)、우실유리벽후도(RVFWT)、우실서장급수축말용적(RVEDV、RVESV)、우실매박량(RVSV)급우실사혈분수(RVEF)、TAPSE、이첨판서장조기급만기혈류속도봉치(E봉、A봉)、E/A비치급E봉감속시간(EDT)。선택학정평개CHF예후적가고지표。결과여대조조비교,CHF조적RVDd、RAA、RVA、RVEDV、RVESV、RVSV、A봉、E봉증대(P<0.01～0.001)；RVFWT、TAPSE、E/A、EDT급RVEF강저(P<0.01～0.001);TAPSE여RVEF급LVEF정현저정상관(r=0.76 급r=0.78,P<0.001)。수방(20±11)개월기간，유12례발생심원성졸사(SCD)。경비변량분석학정RVDd>31 mm、TAPSE≤14 mm、LVEF<35%화EDT<120 ms가작위판단심공능NYHA Ⅲ～Ⅳ급적가고지표(P<0.001),이다변량분석학정TAPSE화LVEF가작위SCD독립적예보인자。결론 TAPSE적측정불수심장절률적영향，재소유CHF환자도용역획득，타불부가반영심공능NYHA분급정도,이차대예후적평개구유중요적림상의의。
Objective　To explore the prognostic value of tricuspid annular plane systolic excusion (TAPSE) in patients with congestive heart failure (CHF) by echocardiography.Methods　The study population consisted of 48 consecutive patients with CHF (NYHA class Ⅲ-Ⅳ) and 30 normal control (NC) group. All study population underwent a complete echocardiographic evaluation that included systematically measuement of right ventricular end-diastolic diameter (RVDd),right atrial area (RAA), right ventricular area (RVA), right ventricular free wall thickness (RVFWT), right ventricular ejection fraction (RVEF), mitral valve peak velocity E, peak velocity A , A/E ratio,peak velocity E deceleration time (EDT) and TAPSE.Results　The parameters of cardiac function in CHF group were significant different from those in NC group (P<0.05～0.001). RVDd,RAA,RVA,RVEDV,RVESV,RVSV,peak velocity E, and peak velocity A were increased (P<0.01～0.001),but RVFWT,TAPSE,A/E ratio ,EDT and RVEF were decreased (P<0.01～0.001), a close correlation were found between TAPSE and RVEF or LVEF (r=0.76 or r=0.78,P<0.001) in patients with CHF. During follow-up period (20±11) months,12 patients died with sudden cardiac death（SCD）. Univariate analyses showed that RVDd>31 mm、TAPSE≤14 mm、LVEF<35% and EDT<120 ms were significant prognostic information to NYHA class Ⅲ～Ⅳ(P<0.001), Multivariate analysis showed that TAPSE and LVEF were independent predictors of outcome.Conclusions　The measurements of TAPSE is easy to obtain in all patients including irrespective of heart rate and rhythm.The TAPSE not only reflects severity of NYHA class ,but also have important value for evalution the prognostic in patients with CHF.