二维超声斑点追踪成像技术对特发性脊柱侧凸患者右心室功能的评价

Evaluation of right ventricular function in idiopathic scoliosis patients by two-dimensional speckle tracking imaging

中文关键词:  二维超声斑点追踪成像技术  特发性脊柱侧凸  右心室功能

英文关键词:Two-dimensional speckle tracking imaging  Idiopathic scoliosis  Right ventricular function

中文摘要:

  【摘要】 目的：应用二维超声斑点追踪成像技术（STI）评价特发性脊柱侧凸患者的右心室功能。方法：选取2009年7月~2010年12月在我院就诊的特发性脊柱侧凸患者41例，Cobb角30°~125°，其中轻度脊柱侧凸（Cobb角<45°）5例，中度（Cobb角45°~80°）31例，重度（Cobb角>80°）5例；选取年龄相匹配的脊柱与心脏正常的人30例作为对照组。脊柱侧凸组与对照组均用GE Vivid 7超声心动图仪行超声心动图检查，先用改良双平面Simpson′s法测量并计算右心室射血分数（RVEF），然后用二维超声STI检测右心室多节段的收缩期二维应变；在两组中选取有三尖瓣关闭不全的病例，通过三尖瓣返流（TVR）估测肺动脉收缩压（PASP），并行组间比较。脊柱侧凸组行肺功能检查，测量用力肺活量（FVC）、第1秒用力呼气流速（FEV1），计算实测值与预计值的百分比（FVC%、FEV1%）。应用线性相关分别分析右心室整体收缩期二维应变与Cobb角、FVC%之间的相关性。结果：3组脊柱侧凸患者的RVEF与对照组比较均无显著性差异（P＞0.05）。重度脊柱侧凸组右心室前壁心尖段、前间隔心尖段、室间隔心尖段、后间隔中间段、后间隔基底段的收缩期二维应变均明显低于对照组（P<0.05），轻、中度脊柱侧凸组与对照组比较无显著性差异（P＞0.05）；重度侧凸组的后间隔基底段的收缩期二维应变显著低于轻度侧凸组（P<0.05），而与中度侧凸组比较无显著性差异（P＞0.05）。侧凸组25例有TVR，对照组18例有TVR，两组PASP比较无显著性差异（P＞0.05）。重度侧凸组的FVC%与FEV1%显著低于轻度侧凸组（P<0.05），中度侧凸组与轻度组、重度组比较均无显著性差异（P＞0.05）。脊柱侧凸患者右心室整体收缩期二维应变与Cobb角呈负相关（r=-0.93，P<0.05），与FVC%间有低相关性（r=0.47，P<0.05）。结论：二维超声STI可敏感地检测出特发性脊柱侧凸患者右心室功能异常，是评价右心室功能的一种有价值的方法；重度特发性脊柱侧凸会引起右心室心肌运动障碍致右心室功能降低。

英文摘要:

  【Abstract】 Objectives: To evaluate the right ventricular function in patients with idiopathic scoliosis using two-dimensional speckle tracking imaging(STI). Methods: 41 idiopathic scoliosis patients admitted in our hospital from July 2009 to December 2010 and 30 healthy subjects with age matched and normal heart(control group) were enrolled in this series. According to the Cobb′s angle(range, 30°-125°), 41 patients were divided into 3 groups: mild(<45°, n=5), moderate(45°-80°, n=31) and severe(>80°, n=5) group. All of the patients and healthy subjects were checked echocardiography using GE Vivid 7 echo machine.Firstly, the ejection fraction of right ventricle(RVEF) was obtained by modified Simpson′s method. Then, the two-dimensional strain of right ventricle multi-section systolic phase was measured by the STI. All of the parameters were compared among the 3 patient groups and the control group. Cases with tricuspid valve regurgitation(TVR) were chosen in patient group and control group, then through TVR the pulmonary artery systolic pressure(PASP) was calculated, which was compared between the other two patient groups. The lung function parameters such as forced vital capacity(FVC) and forced expiratory volume in first second(FEV1) were also checked, and FVC% and FEV1% were calculated either.And the correlation between the whole right ventricular strain and Cobb′s angle, strain and FVC% were analyzed by linear correlation. Results: There was no statistical difference in RVEF between the patient group and control group(P>0.05). The two-dimensional strain of right ventricular anterior wall apex, anterior septal apex, septal apex, mid posterior septum and base post-septum were lower in severe scoliosis group than control group significantly(P<0.05), while there was no significant difference between mild or mid patient group and control group(P>0.05). And the strain of base posterior septum in severe group were lower than in mild group(P<0.05), while no significant difference in moderate group(P>0.05). TVR was positive in 25 patients and 18 healthy subjects, and there was no statistical difference in PASP between the 2 groups(P>0.05). FVC% and FEV1% in severe group was lower than in mild group(P<0.05), while no difference was noted between moderate and mild group, moderate and severe group(P>0.05). There was negative correlation between whole right ventricular strain and Cobb′s angle(r=-0.93, P<0.05), while the weak correlation between stain and FVC% was noted(r=0.47, P<0.05). Conclusions: Two-dimensional STI can detect the anomalies of right ventricular function in idiopathic scoliosis patients susceptibly, which is a valuable method for evaluating the right ventricular function. Severe idiopathic scoliosis may disturb the motion of right ventricular myocardium then weaken the right ventricular function.