Rydman Riikka, Söderberg Mårten, Larsen Flemming, Caidahl Kenneth, Alam Mahbubul
Section of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Echocardiography. 2010 Mar;27(3):286-93. doi: 10.1111/j.1540-8175.2009.01015.x. Epub 2010 Jan 22.
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.
由于右心室（RV）解剖结构复杂，对其功能进行评估颇具挑战。我们研究了急性肺栓塞（PE）患者的三尖瓣环收缩期和舒张期位移以及右心室纵向缩短分数，将其作为与几何形态无关的测量指标。对40例PE患者在入院后24小时内及3个月后进行了研究，并与23名健康受试者作为对照。我们从四腔心视图记录三尖瓣环平面收缩期（TAPSE）和舒张期（TAPDE）位移，并计算右心室缩短分数为TAPSE/右心室舒张期长度。舒张期右心室功能定义为心房收缩期三尖瓣环平面位移幅度与三尖瓣环平面总舒张期位移之比（心房/总TAPDE）。在急性期，与健康受试者相比，PE患者的TAPSE降低（19±5 vs. 26±4 mm，P<0.001），右心室压力升高（相对于正常）的患者降低幅度更大（16.6±5 vs. 20.5±5 mm，P<0.05）。与健康受试者相比，患者的心房/总TAPDE升高（47±13% vs. 38±7%，P<0.001），且在随访期间恢复正常。尽管患者在3个月后无症状，但与健康受试者相比，TAPSE恢复不完全（21.4±4 vs. 26±4 mm，P<0.001）。急性PE时，右心室收缩期和舒张期功能均受损。舒张期功能恢复快于收缩期；因此，心房对右心室充盈的贡献可能是跟踪PE患者舒张期功能变化的有用指标。
