多普勒组织成像评估左向右分流先天性心脏病平均右心房压

目的探讨应用组织多普勒技术测量三尖瓣环运动相关参数，评估左向右分流先天性心脏病平均右心房压（mRAP）的价值。方法应用组织多普勒技术测量41例心脏病患者三尖瓣环收缩期峰值速度（Sm）、舒张早期峰值速度（Em）、舒张末期峰值速度（Am）、右心室等容收缩间期（IVCTm）、右心室等容舒张间期（IVRTm），IVCTm、IVRTm用心率校正得出IVCTc、IVRTc；多普勒测量三尖辩口舒张早期前向峰值血流速度（E）；计算Em／Am、E／Em，以心导管测量先天性心脏病患者的mRAP。结果mRAP≥8mmHg的患者，IVRTc较短，而E／Em较高。IVRTc与mRAP呈负相关（r=-0.81，P〈0.01），E／Em与mRAP呈正相关（r=0.83，P〈0.01），其中IVRTc≤84.5ms或E／Em≥6.5判定mRAP≥8mmHg敏感度、特异度分别86.7％、72.0％，93.3％、84.6％。结论多普勒组织成像检测三尖瓣环IVRTc及E／Em能定量估测左向右分流先天性心脏病mRAP。

Evaluation of mean right atrial pressure in paients with left to right shunt congenital heart disease by tissue Doppler image of tricuspid annulus

Objective To evaluate mean right atrial pressure （mRAP） in patients with left to right shunt congenital heart disease by using tricuspid annular tissue Doppler imaging. Methods Forty-one patients with left to right shunt congenital heart disease were enrolled. Systolic myocardial velocity （Sin）, early diastolic myocardial myocardial velocity（Em） and late diastolic velocity（Am）, isovolumic contraction time（IVCTm）, isovolumic relaxation time（IVRTm） were measured from tricuspid annulus by tissue Doppler imaging. IVCTm, IVRTm were corrected for heart rate （IVCTc, IVRTc）. Early tricuspid inflow velocity （E） were measured. Era/Am, E/Em were caculated. All patients underwent cardiac catheterization,and mean right atrial pressure was measured. Results IVRTe was lower and E/Em was higher in patients with mRAP≥8 mm Hg when all the patients were analyzed. There were significant negative correlation between mRAP and IVRTc（r=-0.81, P〈0.01）, positive correlation existed between mRAP and E/Era （r=0.83, P 〈0.01）. IVRTc≤84.5 ms had a sensitivity of 86.7% and a specificity of 72.0%,E/Em≥6.5 had a sensitivity of 93.3% and a specificity of 84.6% for predicting mRAP≥8 mm Hg. Conclusion mRAP in patients with left to right shunt congenital heart disease can be predicted by using IVRTc and E/Em detected from tricuspid annular tissue Doppler imaging.