Meng Hong, Chandrasekaran Krishnaswamy, Villarraga Hector R, Shah Aijaz A, Kittipovanonth Maytinee, Cha Stephen S, Pellikka Patricia A, Seward James B
Fuwai Hospital, Beijing, China.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Echocardiography. 2019 May;36(5):877-887. doi: 10.1111/echo.14328. Epub 2019 Apr 15.
To evaluate whether global peak systolic strain (PSS) and peak systolic strain rate (PSSR) derived from velocity vector imaging (VVI) allow early recognition of regional and global right ventricular (RV) dysfunction and the impact of this on left ventricular (LV) function in patients with pulmonary hypertension (PHT).
RV function is an important determinant of prognosis in patients with heart failure, pulmonary hypertension, heart transplant, and congenital heart diseases. However, evaluation of the right ventricle is often limited by its complex geometry and inadequate visualization of RV free wall. Furthermore, the impact of RV dysfunction on the LV function is not well elucidated.
Ninety-nine participants, 35 control patients with normal RV systolic pressure (RVSP) (<30 mm Hg) and 64 patients with PHT (25 with mild-to-moderate increase in RVSP [≥36 and <60 mm Hg] and 39 with severe increase in RVSP [≥60 mm Hg]), underwent comprehensive echo-Doppler assessment and velocity vector imaging (VVI) for strain rate analysis. RV regional peak systolic and diastolic tangential velocity, strain, and strain rate were obtained from the basal, mid and apical segments of the RV free wall and interventricular septum (IVS) from apical 4-chamber view at end-expiration. Similar data were obtained from eighteen LV segments from apical 4-chamber, 2-chamber, and long-axis views.
Peak systolic strain, strain rate, and tangential velocity at all segments in the RV free wall and IVS were decreased compared to controls in patients with PHT (P < 0.001). Significant correlation (r > 0.60; P < 0.001) was noted between RVSP and systolic and diastolic strain and strain rate at basal segment in IVS and global RV function. Peak early diastolic strain rate at all segments was also decreased in PHT patients compared with control patients (P < 0.01). Furthermore, RV systolic and diastolic strain and strain rate were lower in group 2 with mild-to-moderate hypertension while the conventional echo parameters were normal. Except for IVS segments, other LV segments had no statistical differences in systolic and diastolic velocity, strain, and strain rate compared to controls. However, they were lower than the published normal range.
Strain and strain rate derived from VVI demonstrates early recognition of systolic and diastolic RV dysfunction in patients with PHT compared to controls. PHT is associated with global and regional RV systolic and diastolic dysfunction. Systolic and diastolic strain and strain rate from LV was lower compared to controls but were not statistically significant. This may indicate subclinical LV dysfunction in these patients, suggesting that conventional LV function parameters may not be sensitive to recognize subclinical LV dysfunction.
评估基于速度向量成像（VVI）得出的整体收缩期峰值应变（PSS）和收缩期峰值应变率（PSSR）能否早期识别肺动脉高压（PHT）患者的局部和整体右心室（RV）功能障碍及其对左心室（LV）功能的影响。
RV功能是心力衰竭、肺动脉高压、心脏移植和先天性心脏病患者预后的重要决定因素。然而，对右心室的评估常因其复杂的几何形状和右心室游离壁显示不清而受到限制。此外，RV功能障碍对LV功能的影响尚未完全阐明。
99名参与者，35名右心室收缩压（RVSP）正常（<30 mmHg）的对照患者和64名PHT患者（25名RVSP轻度至中度升高[≥36且<60 mmHg]，39名RVSP重度升高[≥60 mmHg]），接受了全面的超声多普勒评估和用于应变率分析的速度向量成像（VVI）。在呼气末，从心尖四腔心切面获取右心室游离壁和室间隔（IVS）基底部、中部和心尖部节段的右心室局部收缩期和舒张期峰值切线速度、应变及应变率。从心尖四腔心、两腔心和长轴切面的18个左心室节段获取类似数据。
与对照组相比，PHT患者右心室游离壁和IVS所有节段的收缩期峰值应变、应变率和切线速度均降低（P < 0.001）。RVSP与IVS基底部节段的收缩期和舒张期应变及应变率以及整体右心室功能之间存在显著相关性（r > 0.60；P < 0.001）。与对照患者相比，PHT患者所有节段的舒张早期峰值应变率也降低（P < 0.01）。此外，轻度至中度高血压的2组患者右心室收缩期和舒张期应变及应变率较低，而传统超声参数正常。除IVS节段外，其他左心室节段的收缩期和舒张期速度、应变及应变率与对照组相比无统计学差异。然而，它们低于已公布的正常范围。
与对照组相比，基于VVI得出的应变和应变率可早期识别PHT患者的收缩期和舒张期右心室功能障碍。PHT与整体和局部右心室收缩期及舒张期功能障碍相关。左心室的收缩期和舒张期应变及应变率与对照组相比降低，但无统计学意义。这可能表明这些患者存在亚临床左心室功能障碍，提示传统的左心室功能参数可能对识别亚临床左心室功能障碍不敏感。
