CAJ | 학술논문

目的：应用组织多普勒（ TDI）及应变率成像（ SRI）技术评价无右心衰症状的二尖瓣狭窄（ MS）患者的右心室（ RV）整体及局部心肌收缩功能。方法单纯性MS患者40例，健康对照组20例。测量左心房前后径（ LAD）、肺动脉收缩压（ PASP），描记二尖瓣口面积（ MVA），M型超声测量三尖瓣环的收缩期位移（ TAPSE），计算右室面积变化率（ RVFAC）。应用TDI技术测量三尖瓣环收缩期速度（ Tric-s），等容收缩期速度（ IVV），等容收缩期加速度（IVA）。 SRI测量右心室游离壁（RVFW）及室间隔的收缩期应变（S）及应变率（SR），RVFW及室间隔的S及SR的均值作为RV整体长轴的S和SR。并将S和SR与PASP进行相关性分析。结果与对照组相比，MS组的LAD及PASP明显增高（P＜0．01）。 MS组的TAPSE 及Tri -s、IVV、IVA明显低于对照组（P＜0．01或 P＜0．05）。 RV长轴整体S及SR，RVFW基底段及中段的S及SR，室间隔基底段S明显低于对照组（P＜0．05或P＜0．01），室间隔中段S及室间隔各段SR在两组间无差别。 RV长轴整体S、SR均与PASP呈负相关，相关系数分别为r＝-0．71，r＝-0．59（P均＜0．05）。结论应用TDI及SRI技术可以早期发现MS患者RV整体及局部功能的受损情况。
목적：응용조직다보륵（ TDI）급응변솔성상（ SRI）기술평개무우심쇠증상적이첨판협착（ MS）환자적우심실（ RV）정체급국부심기수축공능。방법단순성MS환자40례，건강대조조20례。측량좌심방전후경（ LAD）、폐동맥수축압（ PASP），묘기이첨판구면적（ MVA），M형초성측량삼첨판배적수축기위이（ TAPSE），계산우실면적변화솔（ RVFAC）。응용TDI기술측량삼첨판배수축기속도（ Tric-s），등용수축기속도（ IVV），등용수축기가속도（IVA）。 SRI측량우심실유리벽（RVFW）급실간격적수축기응변（S）급응변솔（SR），RVFW급실간격적S급SR적균치작위RV정체장축적S화SR。병장S화SR여PASP진행상관성분석。결과여대조조상비，MS조적LAD급PASP명현증고（P＜0．01）。 MS조적TAPSE 급Tri -s、IVV、IVA명현저우대조조（P＜0．01혹 P＜0．05）。 RV장축정체S급SR，RVFW기저단급중단적S급SR，실간격기저단S명현저우대조조（P＜0．05혹P＜0．01），실간격중단S급실간격각단SR재량조간무차별。 RV장축정체S、SR균여PASP정부상관，상관계수분별위r＝-0．71，r＝-0．59（P균＜0．05）。결론응용TDI급SRI기술가이조기발현MS환자RV정체급국부공능적수손정황。
Objective To investigate the global and regional longitudinal systolic function of right ventricle ( RV) using tis-sue Doppler imaging (TDI )and strain rate imaging (SRI) in mitral stenosis (MS) patients without clinical symptoms of right heart failure .Methods Conventional echocardiography and TDI , SRI analysis were performed in 40 MS patients and 20 normal subjects.left atrial end-systolic diameter (LAD), pulmonary artery systolic pressure (PASP) were measured. End-diastolic and end-systolic areas of RV were measured from the apical four -chamber view to calculate RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPS) was determined in apical four -chamber view. Parameters derived from TDI and SRI included tricuspid annulus S -wave velocity ( Tric-s) , peak isovolumic contraction velocity (IVV) and myocardial acceleration during isovolumic contraction (IVA), longitudinal systolic strain (S) and strain rate (SR) of right ventricular free wall (RVFW) and septum.The average of RVFW and septum S, SR were defined as the whole S, SR of RV.Correlation between S , SR and PASP were analyzed .Results Compared with normal subjects , LAD and PASP were significantly higher in patients with MS (P<0.01), TAPSE and Tric-s (IVV) and (IVA) were significantly lower in MS patients (P<0.01 or P<0.05).S and SR of the global RV and all segments of RVFW were sig-nificantly reduced in MS patients ( P<0 .05 or P<0 .01 ) , regional longitudinal S was significantly reduced in the basal septum (P<0.05).Correlation analysis indicated a significant relationship between the PASP and global S , SR of RV. Conclusion RV global and regional systolic function evaluated by TDI and SRI analysis in patients with MS has shown de -creased before right heart failure .