2D-STI 评价肺动脉压正常SSc 患者 右室收缩功能的临床研究

Evaluation of right ventricular systolic function in systemic sclerosis patients with normal pulmonary arterial pressure by speckle tracking imaging

摘要:

目的 应用二维斑点追踪成像（2D-STI）评估早期系统性硬化病（SSc）患者右室心肌收缩功 能的变化特点。方法 选取2014 年10 月-2017 年3 月于成都大学附属医院及川北医学院附属医院收治的未 合并肺动脉高压（PAH）SSc 患者，并选取同期来院体检的健康人群，受试对象均接受超声心动图检查。应用 2D-STI 测量右室侧壁收缩期整体纵向峰值应变（GLS）及应变率（GLSRs），心尖段、中间段、基底段应变（LS） 及应变率（LSRs），对各研究对象的参数进行比较，并分析影响右室收缩期及的主要因素。结果 SSc 组与 对照组GLS、GLSRs、基底段LS 及LSRs、中间段LS 比较有差异（P <0.05），而心尖段LS 及LSRs、中间段 LSRs 比较无差异（P >0.05）。dcSSc 组与lcSSc 组比较GLS、基底段LS 及LSRs、中间段LS 比较有差异（P <0.05）， 而GLSRs、心尖段LS 及LSRs、中间段LSRs 比较无差异（P >0.05）。结论 未合并PAH 的SSc 患者右室收 缩功能降低，弥漫皮肤型患者较局限皮肤型患者受损更严重。2D-STI 可早期评价右室心肌整体及局部收缩 力学的改变。

Abstract:

Objective To evaluate the right ventricular systolic function by two-dimensional speckle tracking imaging (2D-STI) in the patients with systemic sclerosis (SSc) without pulmonary hypertension (PAH). Methods A total of 30 patients with SSc without PAH were enrolled, 16 had limited cutaneous SSc (lcSSc), 14 patients had diffuse cutaneous SSc (dcSSc). For comparison, 22 matched healthy control subjects were included. All subjects underwent transthoracic echocardiography. The right ventricular free wall global longitudinal peak systolic strain (GLS) and strain rate (GLSRs), and longitudinal peak systolic strain (LS) and strain rate (LSRs) of basal segment, middle segment and apical segment were measured by 2D-STI respectively. Every parameter was compared. The main factors affecting the right ventricular LS and LSRs were analyzed. Results The strain and strain rate curves of the segments of the right ventricular lateral wall were in regular distribution, and the basal segment was the largest, and the apical segment was the smallest in every group. GLS and GLSRs of the right ventricular lateral wall, basal segment LS and LSRs, and middle segment LS were significantly different between the SSc patients and the healthy controls (P < 0.05). The patients with dcSSc showed worse values in GLS, basal segment LS and LSRs and middle segment LS as compared with the patients with lcSSc (P < 0.05). Conclusions The right ventricular systolic function is damaged in the patients with SSc without PAH. The patients with dcSSc show worse function as compared to the patients with lcSSc. 2D-STI analysis can detect the subtle right ventricular global and part systolic dysfunction.