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目的探讨组织多普勒成像技术评价慢性肺动脉高压患者右心室功能及与肺动脉收缩压的关系。方法对2006年10月至2007年3月在复旦大学华山医院心内科就诊的35例慢性肺动脉高压和35名正常人进行组织多普勒超声心动图检查,从心尖四腔观获得右室侧壁三尖瓣环的运动速度频谱图,测量收缩期S波峰速度(Sm),舒张早期负向E波峰速度(Em),舒张晚期负向A波峰速度(Am),等容收缩时间(IVCT)和等容舒张时间(IVRT)。结果肺动脉高压组Sm、Em和Em/Am均低于对照组,肺动脉高压组Am、IVRT均高于对照组,差异均有显著性意义。IVRT和肺动脉收缩压(PASP)存在显著的正相关(r=0.78,P<0.01),IVRT≥60ms诊断肺动脉高压的敏感度和特异度分别为83%和86%。结论慢性肺动脉高压导致右心收缩及舒张功能减退,当连续多普勒不能估测肺动脉收缩压时,组织多普勒可作为肺动脉收缩压估测的新方法。
Objective To evaluate the relationship between right ventricular function and pulmonary artery systolic pressure in patients with chronic pulmonary hypertension by tissue Doppler imaging. Methods Tissue Doppler echocardiography was performed in 35 patients with chronic pulmonary hypertension and 35 normal subjects who were admitted to Department of Cardiology, Huashan Hospital, Fudan University from October 2006 to March 2007. The right ventricular wall Tricuspid annulus motion velocity spectrum, systolic S wave velocity (Sm), early diastolic E wave velocity (Em), negative diastolic A wave velocity (Am), isovolumic contraction time (IVCT) and Isovolumic relaxation time (IVRT). Results The levels of Sm, Em and Em / Am in pulmonary arterial hypertension group were lower than those in control group. The levels of Am and IVRT in pulmonary arterial hypertension group were significantly higher than those in control group. The differences were significant. There was a significant positive correlation between IVRT and pulmonary artery systolic pressure (PASP) (r = 0.78, P <0.01). The sensitivity and specificity of IVRT≥60 ms in diagnosing pulmonary hypertension were 83% and 86%, respectively. Conclusions Chronic pulmonary hypertension leads to right ventricular systolic and diastolic dysfunction. When continuous Doppler can not estimate pulmonary artery systolic pressure, tissue Doppler can be used as a new method to estimate pulmonary systolic pressure.