Platz Elke, Hassanein Amira H, Shah Amil, Goldhaber Samuel Z, Solomon Scott D
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA.
Echocardiography. 2012 Apr;29(4):464-70. doi: 10.1111/j.1540-8175.2011.01617.x. Epub 2012 Jan 26.
Right ventricular (RV) dysfunction is a frequent consequence of pulmonary embolism (PE) and a marker of increased risk. However, current qualitative methods assessing RV function are imprecise. We sought to determine whether RV strain analysis would have clinical utility in patients with PE compared with normal controls.
We compared 75 acute PE subjects (mean age 54 ± 16) with 30 normal controls (mean age 50 ± 15). Regional RV longitudinal strain was assessed using offline speckle tracking software to obtain strain and strain rate data from the basal, mid, and apical free wall and septum. Global RV free wall and septal strain was significantly reduced in PE subjects (-14.17 (±5.96) vs -24.92 (±4.16), P < 0.0001; -14.99 (±5.55) vs -18.54 (±7.34), P = 0.0082). Regional RV strain was markedly reduced in PE subjects in all regions of the free wall and in the mid and basal septum (P < 0.05). Strain rates of PE subjects were significantly reduced in all segments of the RV free wall (P < 0.05). In 36 PE subjects with regional RV dysfunction ("McConnell sign"), strain in the apical free wall was significantly reduced in comparison to those without (-10.08 vs -13.51; P = 0.0420), in parallel with higher RV:LV ratios (1.30, ±1.01 vs 0.78, ±0.16; P = 0.0035) and lower RV fractional area change (32.06, ±14.42 vs 42.52, ±11.61; P = 0.0021).
Regional RV longitudinal strain is altered in the free wall and mid and basal septum in subjects with acute PE. Strain rates are only reduced in the RV free wall.
右心室（RV）功能障碍是肺栓塞（PE）常见的后果，也是风险增加的一个标志。然而，目前评估RV功能的定性方法并不精确。我们试图确定与正常对照组相比，RV应变分析在PE患者中是否具有临床实用性。
我们将75例急性PE患者（平均年龄54±16岁）与30例正常对照者（平均年龄50±15岁）进行比较。使用离线斑点追踪软件评估局部RV纵向应变，以获取来自基底、中间和心尖游离壁及室间隔的应变和应变率数据。PE患者的整体RV游离壁和室间隔应变显著降低（-14.17（±5.96）对-24.92（±4.16），P<0.0001；-14.99（±5.55）对-18.54（±7.34），P = 0.0082）。PE患者游离壁所有区域以及中间和基底室间隔的局部RV应变均显著降低（P<0.05）。PE患者RV游离壁所有节段的应变率均显著降低（P<0.05）。在36例存在局部RV功能障碍（“McConnell征”）的PE患者中，与无此征的患者相比，心尖游离壁的应变显著降低（-10.08对-13.51；P = 0.0420），同时RV:LV比值更高（1.30，±1.01对0.78，±0.16；P = 0.0035），RV面积变化分数更低（32.06，±14.42对42.52，±11.61；P = 0.0021）。
急性PE患者游离壁以及中间和基底室间隔的局部RV纵向应变发生改变。应变率仅在RV游离壁降低。
