Department of Ultrasonography, The People's Hospital of Hunan Province, No. 61 Jiefang West Road, Changsha, 410005, China.
Int J Cardiovasc Imaging. 2022 Oct;38(10):2199-2208. doi: 10.1007/s10554-022-02626-8. Epub 2022 May 20.
Strain parameters on speckle tracking echocardiography (STE) have been proposed as effective indexes for evaluating right ventricular (RV) function. This pilot study investigated the role of STE-derived strain parameters in assessing global and regional RV myocardial mechanical changes in patients with acute pulmonary embolism (PE) before and after thrombolytic therapy. In this case-control study, a total of 73 PE patients, 34 with pulmonary hypertension (PH) and 39 without PH, who underwent thrombolytic therapy were included. Healthy volunteers were included as controls. The peak longitudinal systolic strain (PLSS) and time to PLSS (TTP) for the global and regional RV were analyzed by STE software immediately before and 14 days after thrombolytic therapy. Changes in STE-derived strain parameters and conventional ultrasound parameters were compared. PLSS and TTP decreased before treatment in PE patients compared with measurements in the control group, particularly in those with PH. Also, the strain parameters decreased more significantly for the free wall than for the septum wall (P < 0.05). Moreover, the RV diastolic diameter (RVDD) and RV/left ventricular (LV) diameter ratio increased, while RV fraction shortening (RVFS), RV fractional area change (RVFAC), tricuspid regurgitation pressure gradient (TRPG), and tricuspid annular peak systolic excursion (TAPSE) decreased (P < 0.05). The global strain parameters for the RV were positively correlated with RVDD and RV/LV diameter ratio, but negatively correlated with RVFS, RVFAC, TRPG, and TAPSE (P < 0.05). After treatment, the strain parameters differed significantly between PE patients with PH and controls but did not differ between PE patients without PH and controls. STE-derived parameters are effective for detecting changes in global and regional RV function in PE patients with or without acute PH.
应变参数斑点追踪超声心动图（STE）已被提议作为评估右心室（RV）功能的有效指标。本研究旨在探讨STE 衍生应变参数在评估急性肺栓塞（PE）溶栓治疗前后 RV 心肌整体和局部机械变化中的作用。在这项病例对照研究中，共纳入 73 例接受溶栓治疗的 PE 患者，其中 34 例合并肺动脉高压（PH），39 例不合并 PH，健康志愿者作为对照组。应用 STE 软件分析 RV 整体和局部的最大纵向收缩期应变（PLSS）和 PLSS 达峰时间（TTP），分别于溶栓治疗前和治疗后 14 天进行。比较 STE 衍生应变参数和常规超声参数的变化。PE 患者治疗前 PLSS 和 TTP 较对照组降低，尤其是 PH 患者。应变参数的降低在游离壁比室间隔壁更明显（P < 0.05）。此外，RV 舒张末期直径（RVDD）和 RV/LV 直径比增加，而 RV 收缩分数（RVFS）、RV 局部面积变化（RVFAC）、三尖瓣反流压差（TRPG）和三尖瓣环收缩期位移（TAPSE）降低（P < 0.05）。RV 整体应变参数与 RVDD 和 RV/LV 直径比呈正相关，与 RVFS、RVFAC、TRPG 和 TAPSE 呈负相关（P < 0.05）。治疗后，PH 组 PE 患者与对照组的应变参数差异有统计学意义，而非 PH 组 PE 患者与对照组的应变参数差异无统计学意义。STE 衍生参数可有效检测有无急性 PH 的 PE 患者 RV 整体和局部功能的变化。
