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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,Echo Pac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。
Purpose Echocardiography right ventricular function is suitable for atrial fibrillation patients with little research. In this study, cardiac magnetic resonance imaging (MRI) as the gold standard, echocardiography in patients with atrial fibrillation evaluation of right heart structure and function of the sensitivity, specificity and threshold were discussed. Methods From September to December 2014, 16 patients with atrial fibrillation were prospectively collected from Department of Cardiology, Peking Union Medical College Hospital. Clinical data, echocardiographic parameters and MRI examination were collected. Stored four-chamber apex four-dimensional dynamic images, Echo Pac software generates right ventricular myocardium strain curve. Results Left ventricular end-diastolic diameter and left ventricular end diastolic volume, left and right anterior and posterior diameter, right atrial diameter and MRI corresponding diameter, right ventricular end-diastolic and end-systolic area and MRI right ventricular volume were significantly correlated. Right ventricle myocardial systolic longitudinal peak strain (PLSS-MID), lateral tricuspid annulus systolic displacement (TAPSE), and tissue Doppler lateral ventricle tricuspid annulus systolic peak velocity (S ’ The ejection fraction (MRI-RVEF) was linearly correlated. ROC curve analysis showed that the area under the curve of right ventricular systolic function parameter (PLSS-MID) was the largest (0.836). The absolute value of <17% showed a lower sensitivity (0.909) and a higher specificity (0.800) in RV systolic function. Bland-Altman analysis, 2.5 × PLSS-MID and MRI-RVEF consistency is good. (P <0.05), the PLSS, PLSS-MID and epicardial PLSS in patients with RVEF decline group were significantly lower than those with normal RVEF in patients with RVEF decline (P < 18.4% vs. -23.9%, P = 0.011). Conclusions The existing S ’and TAPSE in right ventricular systolic function parameters are also suitable for patients with atrial fibrillation. The sensitivity and specificity of PLSS derived from speckle tracking technique are better. The 2.5 × PLSS-MID can be used to predict MRI-RVEF. Recommended combined TAPSE, S ’and PLSS and other indicators of atrial fibrillation in patients with right ventricular dysfunction screening.