超声心动图评价右心室功能的价值

右心室功能是心脏疾病的一项重要指标。临床中,二维超声已经用于右心室功能的评价。一些新的技术包括组织多普勒、应变率成像、实时三维超声和造影剂超声可以进一步加强对右心室功能的评价。     

肺高压患者右心室功能的超声心动图评价

肺高压是一类以肺小动脉血管重构为特征的恶性肺血管疾病,往往由于肺血管阻力(pulmonary vascular resistance,PVR)进行性升高并最终导致患者右心衰竭而死亡[1],其中右心室的评估是判断疾病严重程度和预后的关键。超声心动图作为一种应用广、价格低的无创技术,可以通过右心室形态学变化、左右心室相互影响、右心室收缩功能变化等指标直接或间接反映右心室功能。本文详细介绍超声心动图     

超声心动图对马凡氏综合征患者的右心室收缩功能的评价

目的用超声心动图评价成年马凡氏综合征（Marfan syndrome,MFS）患者是否存在右心室收缩功能不全。方法41例MFS患者及43例正常对照者行M型、二维及组织多普勒超声心动图。记录三尖瓣环收缩期位移（tricuspid annular plane systolic excursion,TAPSE）、右心室面积缩小率（fractional are achange,FAC）及组织多普勒三尖瓣环收缩速度（S。）。结果MFS患者右心室收缩功能指标虽处于正常范围,但均低于正常对照[TAPSE：（21±2）mm口s．（26±1）mm,P〈O．01;FAC：36％±2％vs．42％±3％,P〈O．01;Su：（12±0．3）cm／svs．（16±0．9）cm／s,P〈0．01]。结论MFS患者存在右心室收缩功能不全,提示MFS可能累及右心室心肌。     

超声心动图评估慢性心力衰竭患者左心室重构研究进展

由物理或病理原因引起心脏损伤后导致心肌基因表达、分子水平、细胞水平及基质发生变化,最终出现心脏大小、形状和功能变化的过程称为心脏重构,其受血流动力学、神经体液激活及其它多种因素的影响.除了心肌细胞外,纤维母细胞增殖、胶原降解等都参与了心脏重构的过程.心脏重构可分为生理性重构和病理性重构,后者可由多种原因导致,如心肌梗死、压力负荷过重、容量负荷过重、心肌炎和心肌病等.心肌细胞的肥大、坏死、凋亡及纤维化等使心脏整体呈现球形变的趋势[1].心脏重构与心力衰竭的进展密切相关,并且是心力衰竭预后不良的征兆.伴有明显心脏重构的患者,心脏功能会进行性恶化.研究显示,心脏重构程度越重,患者预后越差,致死率和致残率越高[2].可见,准确评价慢性心力衰竭患者心室重构对于判断病情及预后都至关重要.     

超声心动图检测右心室功能障碍

右心室(RV)功能损害既可由右心系统疾病引起,也可由左心系统疾病或心瓣膜病变引起。现将超声心动图评估以由右心系统疾病引起的右心功能损害综述如下。1RV压力负荷的评估无肺动脉(PA)狭窄时,RV压力与PA压力相等。典型RV压力负荷过重时,RV壁增厚>4mm(常见于先心病)或者RV扩大(后     

双腔右心室的超声心动图诊断

本文报告应用超声心动图诊断81例双腔右心室患者，其中手术治疗72例，超声诊断符合率833％。结果表明：室间隔缺损是最常见的并发畸形。通过不同切面可清晰地显示分割右室腔引起流出道狭窄的异常肌束。大动脉短轴、剑突下二尖瓣水平短轴及右室流出道长轴切面可提供双腔右心室的诊断和鉴别诊断非常有价值的信息。多普勒技术也有助于诊断和评价血流动力学，超声心动图是目前诊断双腔右心室最为实用的方法。     

超声心动图诊断右心室黏液瘤1例

正黏液瘤是心脏最常见的良性肿瘤,好发于左心房者诊断较容易,发生于右心室的少见,较难与其他心脏肿瘤鉴别,现将1例右心室黏液瘤的超声学特征报道如下:1病史简介患者,女性,28岁,因"反复心慌1年余"住院。查体:体温36.7℃,心率82次/分,呼吸19次/分,血压111/80mm Hg,锁骨上淋巴结未及肿大,两肺呼吸音清,心律齐,未闻及病理性杂音,未及心包摩擦音,     

超声心动图对慢性高原病患者右心室结构及功能的初步研究

目的:应用超声心动图检测慢性高原病(chronic mountain sickness,CMS)患者右心室结构与功能变化并探究其临床实用价值。方法:收集29例CMS患者(CMS组)和来自同一海拔高度的29名健康成人志愿者(对照组)作为研究对象,应用超声心动图分别做以下检测:舒张期室间隔厚度(IVSd)、舒张期右室前壁厚度(RVAWd)、舒张期右心室左右径(RV)、三尖瓣收缩期位移(TAPSE)、右心室面积变化分数(FAC)、右心室Tei指数及舒张期主肺动脉(MPA)的宽度,舒张期三尖瓣血流E峰与A峰比值(E/A)、根据三尖瓣返流束的峰值流速(TR)估测主肺动脉的收缩压(PASP)。最后统计所得到的数据,分析CMS对人体右心功能造成的影响。结果:①右心室结构参数:CMS组的RVAWd和RV与对照组比较均有所增加,差异有统计学意义(P0.05);CMS组IVSd与对照组相比无明显变化,差异无统计学意义(P0.05)。②右心室功能参数:CMS组Tei指数跟对照组相比有上升趋势,而CMS组E/A值、TAPSE和FAC相比对照组有明显减低(均P0.05)。③主肺动脉参数:与对照组相比,CMS患者MPA明显增加,PASP明显增高,差异均有统计学意义(均P0.05)。④随着居住年限的增加,CMS患者IVSd无明显改变,差异无统计学意义(P0.05);而RVAWd、RV、MPA、PASP和Tei指数均会随着居住时间的增加有所增加,E/A、TAPSE和FAC出现逐渐减低的趋势,差异均有统计学意义(P0.05)。结论:CMS患者的右心室壁增厚、室腔增大以及收缩和舒张功能均有下降趋势,且以上结构与功能的改变随时间的延长均趋向恶化;CMS患者室间隔未见明显改变,可能是因为左心代偿作用所致。超声心动图在评估CMS患者右心室结构及功能方面具有较高实用价值。     

超声心动图评估慢性阻塞性肺疾病患者的右心室收缩功能改变

目的分析并探讨超声心动图评估慢性阻塞性肺疾病(简称慢阻肺)患者的右心室收缩功能改变。方法选取2013年01月-2014年01月,来我院接受治疗的慢阻肺患者40例,以及健康自愿者40例为对照组。检测并对比患者与对照组肺功能指标与右心室收缩功能指标,分析肺功能指标与右心室收缩功能指标相关性。结果慢阻肺组Ⅲ级、IV级各项肺功能指标与对照组相比有显著差异(P0.05),慢阻肺组Ⅱ级VC与对照组相比无显著差异(P0.05),其他指标与对照组相比有显著差异(P0.05)。慢阻肺组IV级心功能EDV、EF、SV指标低于对照组,有显著差异(P0.05),ESV无显著差异(P0.05);慢阻肺组Ⅱ级、Ⅲ级各项指标与对照组相比,无显著差异(P0.05)。相关性分析结果显示,FEV1指标与FEV1/FVC指标和慢阻肺患者右心室功能指标有相关性(r=0.719,r=0.703)。结论超声心动图对于评估慢阻肺疾病患者右心室收缩功能有一定临床作用,且右心室收缩功能与肺功能指标有显著相关性。     

血流动力学稳定伴右心室功能不全的急性肺血栓栓塞症的临床研究

目的:分析血流动力学稳定伴右心室功能不全(right ventricular dysfunction,RVD)的急性肺血栓栓塞症(简称急性肺栓塞,acute pulmonary embolism,APE)的临床特点、诊断、治疗和预后,以提高对血流动力学稳定伴右心室功能不全的急性肺栓塞的认识.方法:对我院近8年来141例急性肺栓塞患者进行回顾分析,根据超声心动图是否存在右心室功能不全将血流动力学稳定的131例患者分为两组,分别为血流动力学稳定伴RVD(伴RVD组)50例和血流动力学稳定不伴RVD(不伴RVD组)81例,对两组患者的高危因素、临床特点、诊断及治疗等进行分析及比较.结果:血流动力学稳定伴BVD的急性肺栓塞占所有的急性肺栓寒的比率为35.5%.伴RVD组的高危因素主要包括慢性静脉机能不全、陈旧深静脉血栓形成、骨折及手术等.临床表现伴RVD组以呼吸困难最常见(68.0%),与不伴RVD组比较仅晕厥、P2亢进、呼吸频率＞20次/分、心率＞100次/分、低碳酸血症、心电图异常更常见,差异均有统计学意义(P＜0.05).急性肺栓塞患者同时存在晕厥、P2亢进和心电图异常时,对右心室功能不全的阳性预测率可达100%.静脉溶栓治疗伴RVD组(42.0%)明显多于不伴RVD组(9.9%),差异有统计学意义(P＜0.01).结论:血流动力学稳定伴RVD的急性肺栓塞是肺栓塞的重要亚组,对临床上存在晕厥、P2亢进、心电图异常的肺栓塞患者,应尽早行超声心动图检查明确有无RVD,以指导进一步治疗.     

肺动脉高压患者右室功能的多普勒超声评价与进展

肺动脉高压会导致患者右室功能减低,早诊断、早治疗肺动脉高压能明显改善患者的预后。近年来应用多普勒超声技术对肺动脉高压患者右室功能研究的新进展层出不穷,如双多普勒同步技术、Tei指数及三尖瓣环收缩期位移等,均为临床提供了全新的评价肺动脉高压及右室功能的新手段及新参数。     

Correlation Between Right Ventricular Echocardiography Measurements and Functional Capacity in Patients With Pulmonary Arterial Hypertension

BackgroundAccelerometry is an emerging option for real-time evaluation of functional capacity in patients with pulmonary arterial hypertension (PAH). This prospective pilot study assesses the relationship between functional capacity by accelerometry and right ventricular measurements on echocardiography for this high-risk cohort.MethodsPatients with PAH were prospectively enrolled and underwent 6-Minute Walk Test and cardiopulmonary exercise testing. They were given a Fitbit, which collected steps and sedentary time per day. Echocardiographic data included right ventricular global longitudinal, free wall, and septal strain; tricuspid regurgitant peak velocity; tricuspid annular plane systolic excursion; tricuspid annular plane systolic velocity; right ventricular myocardial performance index; and pulmonary artery acceleration time. Pairwise correlations were performed.ResultsThe final analysis included 22 patients aged 13 to 59 years. Tricuspid regurgitant peak velocity had a negative correlation with 6-Minute Walk Test (r = −0.58, P = .02), peak oxygen consumption on exercise testing (r = −0.56, P = .03), and average daily steps on accelerometry (r = −0.59, P = .03), but a positive correlation with median sedentary time on accelerometry (r = 0.64, P = .02). Pulmonary artery acceleration time positively correlated with peak oxygen consumption on exercise testing (r = 0.64, P = .002). There was no correlation between right ventricular strain measurements and functional capacity testing.ConclusionIn this pilot study, tricuspid regurgitant jet and pulmonary artery acceleration time were the echocardiographic variables that correlated most with accelerometry data. With further echocardiographic validation, accelerometry can be a useful, noninvasive, and cost-effective tool to monitor disease progression in patients with PAH.     

Prognostic Value of Computed Tomography Versus Echocardiography Derived Right to Left Ventricular Diameter Ratio in Acute Pulmonary Embolism

BackgroundComputed Tomography (CT) Pulmonary Angiography is the most commonly used diagnostic study for acute pulmonary embolism (PE). Echocardiogram (ECHO) is also used for risk stratification in acute PE, however the diagnostic performance of CT versus ECHO for risk stratification remains unclear.MethodsCT and ECHO right ventricle (RV) and left ventricle (LV) diameters were measured in a retrospective cohort of patients with acute PE. RV:LV diameter ratios were calculated and correlation between CT and ECHO RV:LV ratio was assessed. Sensitivity and specificity for the composite adverse events endpoint of mortality, respiratory failure requiring intubation, cardiac arrest, or shock requiring vasopressors within 30 days of admission were assessed for CT or ECHO derived RV:LV ratio alone and in combination with biomarkers (troponin or B-type natriuretic peptide).ResultsA total of 74 subjects met the inclusion criteria and had a mean age of 62±18 years. The proportion of patients with RV:LV >1 was similar when comparing CT (37.8%) versus ECHO (33.8%) (P = 0.61). A statistically significant correlation was found between CT derived and ECHO derived RV:LV diameter ratio (r = 0.832, P < 0.001). The sensitivity and specificity to predict 30-day composite adverse events for CT versus ECHO derived RV:LV diameter ratio >1 together with positive biomarker status was similar with sensitivity and specificity of 87% and 41% versus 87% and 42%, respectively.ConclusionsIn patients with acute PE, CT and ECHO RV:LV diameter ratio correlate well and identify similar proportion of PE patients at risk for early adverse events. These findings may streamline risk stratification of patients with acute PE.     

Echocardiographic Evaluation of Right Ventricular Function in Patients with Acute Pulmonary Embolism: A Study Using Tricuspid Annular Motion

Assessment of right ventricular (RV) function is a challenge due to complex anatomy. We studied systolic and diastolic tricuspid annular excursion and longitudinal RV fractional shortening as geometry‐independent measures in patients with acute pulmonary embolism (PE). Forty patients with PE were studied within 24 hours after admission and after 3 months, and compared to 23 healthy subjects used as controls. We recorded tricuspid annular plane systolic (TAPSE) and diastolic (TAPDE) excursion from the four‐chamber view and calculated RV fractional shortening as TAPSE/RV diastolic length. The diastolic RV function was defined as the ratio of the amplitude of tricuspid annular plane excursion during atrial systole to total tricuspid annular plane diastolic excursion (atrial/total TAPDE). In the acute stage, the TAPSE was decreased in PE compared to healthy subjects (19 ± 5 vs. 26 ± 4 mm, P < 0.001), with greater reduction in patients with increased, compared to normal, RV pressure (16.6 ± 5 vs. 20.5 ± 5 mm, P < 0.05). The atrial/total TAPDE was increased in patients compared to healthy subjects (47 ± 13% vs. 38 ± 7%, P < 0.001) and normalized during the follow‐up. Although the patients were asymptomatic after 3 months, the TAPSE recovered incompletely as compared to healthy subjects (21.4 ± 4 vs. 26 ± 4 mm, P < 0.001). Both systolic and diastolic RV function are impaired in acute PE. Diastolic function recovers faster than systolic; therefore, the atrial contribution to RV filling may be a useful measure to follow changes in diastolic function in PE. (Echocardiography 2010;27:286‐293)     

Doppler超声心动图技术评价肺栓塞患者右心功能的价值

肺栓塞是一种常见的心血管疾病 ,无论是急性肺栓塞或栓塞性肺动脉高压均可能影响右心功能 ,因此评价肺栓塞患者的右心功能对该疾病的诊断、治疗及评价预后均有重要的临床意义。早在 1992年 Torbicki等[1] 就探讨了关于多普勒超声心动图在肺栓塞诊断中的意义及其优势。本文就 Doppler超声心动图技术对肺栓塞患者右心功能的评价作一简要的综述。1　二维超声心动图用传统的二维超声心动图方法评价右心室收缩功能。右室的收缩功能主要包括以下指标 :(1)右室的容量 ;(2 )右室舒张末期和收缩末期容积 ;(3)右室每搏量 ;(4 )右室心输出量 ;(5 )右室…