Hugues T, Yaici K, Latcu D-G, Rinaldi J-P, Zarqane N, Saoudi N, Gibelin P
Service de cardiologie, centre hospitalier Princesse Grace, Monaco.
Ann Cardiol Angeiol (Paris). 2011 Feb;60(1):27-32. doi: 10.1016/j.ancard.2010.12.006. Epub 2011 Jan 11.
Echocardiographic criteria of right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) differ among published studies. Assessment of RV systolic function remains difficult because of the RV's complex shape. We aimed to evaluate RV systolic function with TAD in patients (pts) with acute PE. TAD (QLAB, Philips Medical Imaging) was based on a tissue-tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement.
Prospective and observational study.
All adults' pts who were diagnosed with PE from December 2008 to December 2009 at Princess Grace Hospital, Monaco were eligible for this study after exclusion of history of heart failure. We evaluated 36 consecutive pts with PE (18 male, mean age 62.7 years), which underwent echocardiography, plasma BNP titration during the first day after admission, and a second echocardiography obtained within 48 hours before discharge.
TAD value were significantly lower in pts with abnormal RV function by echocardiogram (15.9 ± 0.3 vs. 12.7 ± 0.2 ; P = 0.026). Pts with a normal BNP (<80 pg/ml) had an elevated TAD (16.4 ± 0.2 vs. 11.2 ± 0.3 mm ; P < 0.0001). At discharge, echocardiographic data were obtained from 33 pts (mean: 8.3 ± 3.5 days). RV end diastolic diameter, RV to LV diameter, pulmonary arterial systolic pressure, mean pulmonic valve acceleration time, RV FAC, Sa and TAD were significantly improved. There was no difference between TAD among pts with echocardiographic RVD at baseline vs. pts without RVD (14.9 ± 3.7 vs. 16.1 ± 2.9 mm ; P = 0.3). Four pts who deteriorated during short-term observation had substantially lower TAD values than those with uncomplicated courses (7.7 ± 0.4mm vs. 14.6 ± 0.2 mm ; P = 0.001). In conclusion, impaired TAD was associated with decreased RV systolic function in pts with acute PE. To identify the clinical meaning of decreased TAD, larger trials with longer follow-up periods are needed.
已发表的研究中，急性肺栓塞（PE）时右心室功能不全（RVD）的超声心动图标准存在差异。由于右心室形状复杂，评估右心室收缩功能仍然困难。我们旨在评估急性PE患者中使用三尖瓣环位移（TAD）评估右心室收缩功能。TAD（QLAB，飞利浦医学影像）基于一种组织追踪算法，该算法独立于超声束角度用于自动检测三尖瓣环位移。
前瞻性观察性研究。
2008年12月至2009年12月在摩纳哥格蕾丝公主医院被诊断为PE的所有成年患者，排除心力衰竭病史后符合本研究条件。我们评估了36例连续的PE患者（18例男性，平均年龄62.7岁），这些患者在入院后第一天接受了超声心动图检查、血浆脑钠肽（BNP）滴定，并在出院前48小时内进行了第二次超声心动图检查。
超声心动图显示右心室功能异常的患者TAD值显著降低（15.9±0.3对12.7±0.2；P = 0.026）。BNP正常（<80 pg/ml）的患者TAD升高（16.4±0.2对11.2±0.3 mm；P < 0.0001）。出院时，从33例患者（平均：8.3±3.5天）获得了超声心动图数据。右心室舒张末期直径、右心室与左心室直径、肺动脉收缩压、平均肺动脉瓣加速时间、右心室面积变化率（FAC）、三尖瓣环平面收缩期位移（Sa）和TAD均显著改善。基线时超声心动图显示RVD的患者与无RVD的患者之间TAD无差异（14.9±3.7对16.1±2.9 mm；P = 0.3）。在短期观察期间病情恶化的4例患者的TAD值明显低于病程无并发症的患者（7.7±0.4mm对14.6±0.2 mm；P = 0.001）。总之，急性PE患者中TAD受损与右心室收缩功能降低有关。为了确定TAD降低的临床意义，需要进行更大规模、随访期更长的试验。
