Hsiao Shih-Hung, Lee Chiu-Yen, Chang Shu-Mei, Lin Shih-Kai, Liu Chun-Peng
Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
J Am Soc Echocardiogr. 2006 May;19(5):507-14. doi: 10.1016/j.echo.2005.12.003.
To use Doppler tissue imaging to evaluate heart function and to predict rehospitalization rate in progressive systemic sclerosis, we studied 40 patients (limited in 24 patients, diffuse in 16 patients) with chest roentgenography, pulmonary function test, routine echocardiography, and myocardial Doppler tissue. Another 45 volunteers without any sign of heart failure served as the control group. Significant difference of echocardiographic parameters was found in peak transmitral early diastolic velocity, right ventricular (RV) ejection fraction (EF) (RVEF), pulmonary artery systolic pressure, and Doppler tissue parameters of the RV and septum (peak transmitral early diastolic velocity, P = .012; RVEF, P < .0001; pulmonary artery systolic pressure, P < .0001). The parameters derived by pulsed wave Doppler tissue decreased in RV, including peak systolic myocardial velocity (Sm), early diastolic velocity, late diastolic velocity, and myocardial performance index. RVEF and left ventricular EF were estimated by Simpson's method. RV-Sm could be used to identify RV failure. Receiver operating characteristic area under the curve for RV-Sm was 0.935. RV-Sm less than 11 cm/s indicted RVEF less than 40% with sensitivity of 87% and specificity of 86%. Contrary to expectation, pulmonary artery systolic pressure was not so well correlated with RV function. The frequency of admission was reverse correlated with decrement of RV-Sm in patients with RV-Sm less than 12 cm/s. We conclude that in progressive systemic sclerosis, RV systolic dysfunction is common and appears to be a result of pulmonary hypertension, disturbance of myocardial microcirculation, and myocardial fibrosis. Pulmonary hypertension was not well correlated with RV dysfunction; it suggested pulmonary hypertension was not the only cause of RV failure. Primary right heart involvement was the other possible cause. By myocardial Doppler tissue imaging, we can predict the frequency of hospitalization; it suggests simultaneous involvement of heart, skin, lung, and other organs. RV-Sm more than 12 cm/s predicted a decreased likelihood of readmission to the hospital.
为了使用多普勒组织成像评估进行性系统性硬化症患者的心脏功能并预测再住院率，我们对40例患者（24例局限性，16例弥漫性）进行了胸部X线检查、肺功能测试、常规超声心动图和心肌多普勒组织检查。另外45名无心力衰竭迹象的志愿者作为对照组。在二尖瓣舒张早期峰值速度、右心室（RV）射血分数（EF）（RVEF）、肺动脉收缩压以及RV和室间隔的多普勒组织参数（二尖瓣舒张早期峰值速度，P = 0.012；RVEF，P < 0.0001；肺动脉收缩压，P < 0.0001）方面发现了超声心动图参数的显著差异。脉冲波多普勒组织得出的参数在RV中降低，包括收缩期心肌峰值速度（Sm）、舒张早期速度、舒张晚期速度和心肌性能指数。RVEF和左心室EF通过Simpson法估算。RV-Sm可用于识别RV衰竭。RV-Sm的曲线下面积为0.935。RV-Sm小于11 cm/s表明RVEF小于40%，敏感性为87%，特异性为86%。与预期相反，肺动脉收缩压与RV功能的相关性不太好。RV-Sm小于12 cm/s的患者入院频率与RV-Sm的降低呈负相关。我们得出结论，在进行性系统性硬化症中，RV收缩功能障碍很常见，似乎是肺动脉高压、心肌微循环紊乱和心肌纤维化的结果。肺动脉高压与RV功能障碍的相关性不太好；这表明肺动脉高压不是RV衰竭的唯一原因。原发性右心受累是另一个可能的原因。通过心肌多普勒组织成像，我们可以预测住院频率；这表明心脏、皮肤、肺和其他器官同时受累。RV-Sm大于12 cm/s预测再次入院的可能性降低。
