Zhai Ya-Nan, Li Ai-Li, Tao Xin-Cao, Xie Wan-Mu, Wan Jun, Zhang Yu, Zhai Zhen-Guo, Liu Min
Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.
Department of Respiratory and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
Echocardiography. 2020 Apr;37(4):592-600. doi: 10.1111/echo.14639. Epub 2020 Apr 2.
Right ventricular (RV) function is identified as a key determinant of the outcome in patients with pulmonary hypertension (PH). Several studies have assessed the role of peak global longitudinal RV strain in PH patients; however, less emphasis was given to the RV regional longitudinal strain. The aim of this study was to evaluate the regional RV systolic strain in PH patients and investigate the relationship of these parameters with the severity of PH.
RV regional longitudinal peak systolic strain (LPSS) and strain rate (LPSSR) were measured using speckle tracking echocardiography on 100 patients with PH who underwent right heart catheterization, and 29 control subjects. Severe PH was identified by a decreased cardiac index (CI) (<2.0 L/min/m ).
LPSS and LPSSR of the RV free wall were significantly lower in PH patients than control subjects, especially when comparing the basal and mid regions (P < .001). When comparing severe PH and nonsevere PH, basal and mid LPSS and LPSSR were significantly lower (P < .001). RV free wall mid LPSSR correlated with CI (r = -.703, P < .001). In the multiple logistic regression analysis, mid LPSSR was identified as an independent predictor of severe PH (odds ratio 1.82; 95% confidential interval 1.39-2.40; P < .001). In the receiver operating characteristics curve analysis, a cutoff value of mid LPSSR of -0.92 s predicted severe PH, with a sensitivity and specificity of 75.0% and 93.7%, respectively (AUC = 0.889, P < .001).
RV free wall mid longitudinal peak systolic strain rate may be useful for the detection of severely impaired RV performance in PH.
右心室（RV）功能被认为是肺动脉高压（PH）患者预后的关键决定因素。多项研究评估了右心室整体纵向峰值应变在PH患者中的作用；然而，对右心室区域纵向应变的关注较少。本研究的目的是评估PH患者右心室区域收缩期应变，并探讨这些参数与PH严重程度的关系。
对100例行右心导管检查的PH患者和29名对照者，采用斑点追踪超声心动图测量右心室区域纵向峰值收缩期应变（LPSS）和应变率（LPSSR）。严重PH通过心脏指数（CI）降低（<2.0 L/min/m）来确定。
PH患者右心室游离壁的LPSS和LPSSR显著低于对照者，尤其是在比较基底段和中间段时（P <.001）。比较严重PH和非严重PH时，基底段和中间段的LPSS和LPSSR显著降低（P <.001）。右心室游离壁中间段LPSSR与CI相关（r = -.703，P <.001）。在多因素逻辑回归分析中，中间段LPSSR被确定为严重PH的独立预测因子（比值比1.82；95%置信区间1.39 - 2.40；P <.001）。在受试者工作特征曲线分析中，中间段LPSSR的截断值为-0.92 s可预测严重PH，敏感性和特异性分别为75.0%和93.7%（AUC = 0.889，P <.001）。
右心室游离壁中间段纵向峰值收缩期应变率可能有助于检测PH患者严重受损的右心室功能。
