CAJ | 학술논문

目的：超声心动图右室功能指标是否适用于心房颤动患者评估的研究甚少。本研究以心脏磁共振显像(MRI)为金标准,对超声心动图评价心房颤动患者右心结构及功能的敏感性、特异性及阈值进行了探讨。方法2014年9—12月前瞻性收集北京协和医院心内科16例心房颤动患者,收集临床资料、超声心动图参数,同期行 MRI 检查。储存心尖四腔心切面二维动态图像,EchoPac 软件生成右室各层心肌的应变曲线。结果左室舒张末内径与 MRI 左室舒张末容积,左房前后径、右房横径与 MRI 相应内径,右室舒张末及收缩末面积与 MRI 右室容积均明显相关。右室心肌中层收缩期纵向峰应变(PLSS-MID)、侧壁三尖瓣环收缩期位移(TAPSE)及组织多普勒侧壁三尖瓣环收缩期峰速度(S')与 MRI 右室射血分数(MRI-RVEF)呈线性相关。 ROC 曲线分析显示,右心收缩功能参数中PLSS-MID 的曲线下面积最大(0.836),其绝对值<17%诊断右室收缩功能减低的敏感度(0.909)、特异度(0.800)较高。 Bland-Altman 分析中,2.5× PLSS-MID 与 MRI-RVEF 一致性较好。以 RVEF 是否<48%进行分组,则 RVEF 下降组心房颤动患者心内膜 PLSS、PLSS-MID 及心外膜 PLSS 均低于 RVEF正常的心房颤动患者,其中心内膜 PLSS 受损最为明显(-18.4%比-23.9%,P =0.011)。结论现有右室收缩功能参数中 S'、TAPSE 同样适用于心房颤动患者；斑点追踪技术所得 PLSS 对 RVEF 下降的敏感性、特异性更好；2.5× PLSS-MID 有助于预测 MRI-RVEF。推荐联合 TAPSE、S'以及 PLSS 等多种指标来进行心房颤动患者右室功能不全的筛查。
목적：초성심동도우실공능지표시부괄용우심방전동환자평고적연구심소。본연구이심장자공진현상(MRI)위금표준,대초성심동도평개심방전동환자우심결구급공능적민감성、특이성급역치진행료탐토。방법2014년9—12월전첨성수집북경협화의원심내과16례심방전동환자,수집림상자료、초성심동도삼수,동기행 MRI 검사。저존심첨사강심절면이유동태도상,EchoPac 연건생성우실각층심기적응변곡선。결과좌실서장말내경여 MRI 좌실서장말용적,좌방전후경、우방횡경여 MRI 상응내경,우실서장말급수축말면적여 MRI 우실용적균명현상관。우실심기중층수축기종향봉응변(PLSS-MID)、측벽삼첨판배수축기위이(TAPSE)급조직다보륵측벽삼첨판배수축기봉속도(S')여 MRI 우실사혈분수(MRI-RVEF)정선성상관。 ROC 곡선분석현시,우심수축공능삼수중PLSS-MID 적곡선하면적최대(0.836),기절대치<17%진단우실수축공능감저적민감도(0.909)、특이도(0.800)교고。 Bland-Altman 분석중,2.5× PLSS-MID 여 MRI-RVEF 일치성교호。이 RVEF 시부<48%진행분조,칙 RVEF 하강조심방전동환자심내막 PLSS、PLSS-MID 급심외막 PLSS 균저우 RVEF정상적심방전동환자,기중심내막 PLSS 수손최위명현(-18.4%비-23.9%,P =0.011)。결론현유우실수축공능삼수중 S'、TAPSE 동양괄용우심방전동환자；반점추종기술소득 PLSS 대 RVEF 하강적민감성、특이성경호；2.5× PLSS-MID 유조우예측 MRI-RVEF。추천연합 TAPSE、S'이급 PLSS 등다충지표래진행심방전동환자우실공능불전적사사。
Objective It is uncertain that systolic functional markers in ASE 2009 guidelines for echocardiographic assessment of the right heart are suitable to patients with atrial fibrillation (AF). Using magnetic resonance imaging (MRI) as a gold standard, we detected the sensitivity, specificity and threshold of echocardiographic right ventricular markers in AF patients. Methods A total of 16 patients with AF were enrolled in PUMCH from Sep. 2014 to Dec. 2014, prospectively collecting their clinical data, echocardiographic and MRI values. Storing 2D movie images from apical four-chamber view, then using EchoPac system to draw time-strain curves of the endocardium, middle-layer and epicardial layers. Results There were significantly positive correlations of left and right atrial diameters between echocardiography and MRI. Both right ventricular end diastolic area and right ventricular end systolic area were related to MRI right ventricular volumes. Binary logistic regression showed that MRI right ventricular ejection factor (MRI-RVEF) was linearly dependent with right ventricular middle-layer peak longitudinal systolic strain ( PLSS-MID), tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic peak speed (S'). In ROC analysis, PLSS-MID got the largest area under curve (0. 836) among all the right ventricular functional markers. - 17% could be regarded as a threshold of right ventricular dysfunction (0. 909 of sensitivity and 0. 800 of spectivity). In Bland-Altman analysis, 2. 5 multiply PLSS-MID was consistent with MRI-RVEF. AF patients with RVEF < 48% had lower endocardium-PLSS than RVEF ≥48% subgroup ( - 18. 4% vs. - 23. 9% , P = 0. 011). Conclusions S' and TAPSE, which are recommended by ASE guidelines, can also be applied to AF patients, while PLSS-MID has better sensitivity and specificity to identify right ventricular systolic dysfunction. 2. 5 multiply PLSS-MID can help evaluate RVEF. We propose a combination of TAPSE, S' and PLSS to detect right ventricular systolic dysfunction in AF patients.