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目的探讨定量组织速度成像评估特发性肺动脉高压(IPAH)患者右心室非同步运动的意义。方法选择26例IPAH患者和25例正常人,常规测量、计算右心室结构参数(游离壁厚度、舒张末期面积和收缩末期面积、面积变化率)和功能参数[游离壁三尖瓣环收缩期峰速(Sa)、舒张早期峰速(Ea)、舒张晚期峰速、Tei指数]。离线分析右心室3个壁基底段和中间段组织速度曲线,测量QRS波起点至6节段Sa、Ea时限(TQ-S、TQ-E)。计算同一节段3个壁间TQ-S、TQ-E最大差值(Inter-ΔTQ-S、Inter-ΔTQ-E)、同一壁内2个节段间TQ-S、TQ-E最大差值(Intra-ΔTQ-S、Intra-ΔTQ-E)及6节段间TQ-S、TQ-E最大差值(Max-ΔTQ-S、Max-ΔTQ-E)。结果与正常人相比,IPAH患者Inter-ΔTQ-S、Inter-ΔTQ-E、Max-ΔTQ-S、Max-ΔTQ-E明显延长(P<0.001),Intra-ΔTQ-S、Intra-ΔTQ-E略延长(P>0.05)。IPAH患者Max-ΔTQ-S、Max-ΔTQ-E与右心室结构参数和功能参数均有良好相关性。结论IPAH右心室内存在非同步运动,且与右心室结构和功能关系密切。
Objective To investigate the significance of quantitative tissue velocity imaging in assessing right ventricular asynchrony in patients with idiopathic pulmonary hypertension (IPAH). Methods Twenty-six patients with IPAH and 25 normal controls were enrolled in this study. The right ventricular structural parameters (free wall thickness, area of end-diastole, area of end-systole and area change) and functional parameters [free wall tricuspid annulus systolic peak (Sa), early diastolic peak velocity (Ea), late diastolic peak velocity, Tei index]. Off-line analysis of right and left ventricular 3 basal and middle segments of the tissue velocity curve, measuring the beginning of QRS wave to 6 segments Sa, Ea time limit (TQ-S, TQ-E). The maximum difference between TQ-S and TQ-E (Inter-ΔTQ-S, Inter-ΔTQ-E) and the maximum difference of TQ-S and TQ-E between the two segments in the same wall (Intra-ΔTQ-S, Intra-ΔTQ-E) and the maximum difference of TQ-S and TQ-E between the six segments (Max-ΔTQ-S, Max-ΔTQ-E). Results Compared with normal subjects, the levels of Inter-ΔTQ-S, Inter-ΔTQ-E, Max-ΔTQ-S and Max-ΔTQ-E were significantly prolonged in IPAH patients (P < E slightly extended (P> 0.05). There was a good correlation between Max-ΔTQ-S and Max-ΔTQ-E in patients with IPAH and right ventricular structural parameters and functional parameters. Conclusions There is asynchronous movement in the right ventricle of IPAH, which is closely related to the structure and function of the right ventricle.