经食道与经胸超声心动图评估右心室收缩力的对比研究

摘要/Abstract

摘要： 目的比较经胸和经食道超声心动图评估右心室收缩力,分析传统的测量方法和斑点追踪技术测量值的相关性和一致性。方法前瞻性纳入49例患者,所有患者均同步（检查时间相距均不超过24h）行经胸及经食道超声心动图检查,分别测量三尖瓣环收缩期位移、三尖瓣环收缩期速率及右心室游离壁心肌应变。每项参数均采用传统的M型、组织多普勒超声技术及斑点追踪技术。比较经胸及经食道超声心动图的测量值之间的差异。结果传统M型、组织多普勒技术：与经胸超声心动图相比,经食管中段超声心动图的三尖瓣环收缩期位移和速率被低估了（平均±标准差。三尖瓣环收缩期位移：12.1±2.8 mm vs 17.2±3.8 mm;三尖瓣环收缩期速率：6.5±2.2cm/s vs 9.1±2.1cm/s;均为P<0.05）。斑点追踪三尖瓣环收缩期位移,无明显偏差,但变异性大（平均偏差为-0.3mm,95%的一致范围为-8.7至7.9）;TEE的应变和应变率比TTE高（-18.8±3.6 vs -12.8±1.9,P<0.05;-1.1±0.2 vs -0.6±0.1/s,P<0.05）。结论经食道与经胸超声心动图使用传统方法测量的右心室收缩力参数（三尖瓣环收缩期位移、三尖瓣环收缩期速率及右心室游离壁心肌应变）相关性高,通过斑点追踪的三尖瓣环收缩期位移是无偏差的,但在实际应用中需要注意具体测量数据的差异。

关键词: 右心室, 超声心动图, 三尖瓣环收缩期位移, 三尖瓣环收缩期速率, 斑点追踪

Abstract: Objective To investigate the effect of transesophageal echocardiography (TEE) versus transthoracic echocardiography (TTE) in evaluating right ventricular contractibility, as well as the correlation and consistency between conventional measurement method and speckle tracking echocardiography. Methods A total of 49 patients were enrolled in this prospective study, and all patients underwent TTE and TEE simultaneously (with an interval of no more than 24 hours) to measure tricuspid annular plane systolic excursion, tricuspid annular plane systolic velocity, and myocardial strain of the right ventricular free wall. Each parameter was determined by both conventional M-type Doppler tissue imaging and speckle tracking echocardiography, and the measured values were compared between TTE and TEE. Results For conventional M-type Doppler tissue imaging, compared with TTE, TEE underestimated tricuspid annular plane systolic excursion (12.1±2.8 mm vs 17.2±3.8 mm, P<0.05) and tricuspid annular plane systolic velocity (6.5±2.2 cm/s vs 9.1±2.1 cm/s, P<0.05). Tricuspid annular plane systolic excursion measured by speckle tracking showed no significant deviation and a high degree of variability, with a mean deviation of -0.3 mm and a 95% consistency range of -8.7 to 7.9, and strain and strain rate measured by TEE were significantly higher than those measured by TTE (strain: -18.8±3.6 vs -12.8±1.9, P<0.05; strain rate: -1.1±0.2/s vs -0.6±0.1/s, P<0.05). Conclusion There is a high degree of correlation between the parameters of right ventricular contractibility (tricuspid annular plane systolic excursion, tricuspid annular plane systolic velocity, and myocardial strain of the right ventricular free wall) measured by TEE and TTE using the conventional method. Tricuspid annular plane systolic excursion measured by speckle tracking has no deviation, but the difference in the specific data measured should be taken seriously in practical application.

Key words: Right ventricle, Echocardiography, Tricuspid annular plane systolic excursion, Tricuspid annular plane systolic velocity, Speckle tracking

马宁帅, 袁玺. 经食道与经胸超声心动图评估右心室收缩力的对比研究[J]. 心血管病防治知识, 2021, 11(27): 6-9.

MA Ning-shuai, YUAN Xi. Effect of transesophageal versus transthoracic echocardiography in evaluating right ventricular contractibility[J]. Prevention and Treatment of Cardiovascular Disease, 2021, 11(27): 6-9.

参考文献

[1] Bartels K,Karhausen J,Sullivan BL, et al. Update on perioperative right heart assessment using transesophageal echocardiography[J].Semin Cardiothoracic Vasc Anesth, 2014,18(4):341-351.
[2] Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists[J].Anesth Analg ,2014,118(1):21-68.
[3] Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography[J].J Am Soc Echocardiogr,2010:23(7):685-713.
[4] Leather HA, Ama R, Missant C, et al. Longitudinal but not circumferential deformation reflects global contractile function in the right ventricle with, open pericardium[J]. Am J Physiol Heart Circ Physiol,2006,290(2):2369-2375.
[5] Markin NW,Chamsi-Pasha M,Luo J, et al.Transesophageal speckle-tracking echocardiography improves right ventricular systolic function assessment in the perioperative setting[J].J Am Soc Echocardiog,2017,30(2):180-188.
[6] Flo Forner A, Hasheminejad E, Sabate S, et al. Agreement of tricuspid annular systolic excursion measurement between transthoracic and transesophageal echocardiography in the perioperative setting[J]. Int J Cardiovasc Imaging, 2017,33(9):1385-1394.
[7] Korshin A, Gronlykke L, Nilsson JC, et al. The feasibility of tricuspid annular plane systolic excursion performed by transesophageal echocardiography throughout heart surgery and its interchangeability with transthoracic echocardiography[J].Int J Cardiovasc Imaging 2018;34(7):1017-1028.
[8] Nadjia K, Emilie B,Gilles S, et al.Right ventricular diastolic function in aging: a head to head comparison between phase contrast MRI and Doppler echocardiography[J].Int J Cardiovasc Imaging,2021,37(2):663-674.
[9] Buss SJ, Mereles D, Emami M, et al. Rapid assessment of longitudinal systolic left ventricular function using speckle tracking of the mitral annulus[J].Clin Res Cardiol 2012:101(4):273-80.
[10] Kurt M, Tanboga IH, Isik T, et al. Comparison of transthoracic and transesophageal 2-dimensional speckle tracking echocardiography[J].J Cardiothorac Vasc Anesth 2012;26(1):26-31.
[11] 彭锦莉,李文秀,李强强,等. 肺动脉高压患者三尖瓣环收缩期位移/肺动脉收缩压比值与右心导管血流动力学参数的相关性研究[J].心肺血管病杂志, 2021,40(1): 37-42.

[1]	杨富梅, 韩苗, 赵翌霖. 三维超声斑点追踪成像技术用于小儿不典型川崎病冠状动脉病变诊断中的价值分析[J]. 心血管病防治知识, 2023, 13(23): 6-8.
[2]	王江涛. 产前超声心动图对胎儿卵圆孔血流受限或提前闭合的诊断结果分析[J]. 心血管病防治知识, 2023, 13(12): 16-18.
[3]	朱志奇. 3DEA、2DBP技术在冠心病PCI术后患者左室收缩功能评估中的应用[J]. 心血管病防治知识, 2023, 13(10): 20-22.
[4]	曹佳莉, 杨玉青, 何安霞. 早期心尖肥厚型心肌病的心电图及心脏超声特征分析[J]. 心血管病防治知识, 2022, 12(5): 15-19.
[5]	王莉. 不同超声检查方法在冠心病患者室壁节段运动异常诊断中的应用价值对比[J]. 心血管病防治知识, 2022, 12(36): 16-18.
[6]	魏芸. 超声斑点追踪显像评价高血压患者心功能损伤的临床价值研究[J]. 心血管病防治知识, 2022, 12(28): 9-11.
[7]	钟丽丽, 李琪虹, 陈丽旋. 超声心动图检测感染性休克患者血容量及心脏功能的应用价值[J]. 心血管病防治知识, 2021, 11(36): 4-6.
[8]	冷佰桦, 孟瑜. 肥厚型心肌病不同肥厚部位的心电图表现及与超声心动图的相关性[J]. 心血管病防治知识, 2021, 11(36): 11-15.
[9]	颜林淋. 单心动周期实时三维超声心动图对肺动脉高压患者右心功能的评定价值分析[J]. 心血管病防治知识, 2021, 11(28): 6-8.
[10]	涂林村, 邱智广. 肺动脉CTA评估急性肺动脉栓塞严重程度及右心室功能变化的应用价值研究[J]. 心血管病防治知识, 2021, 11(22): 6-8.
[11]	熊丽燕. Tei指数评价妊娠期肺动脉高压右心室功能的研究[J]. 心血管病防治知识, 2021, 11(22): 15-17.
[12]	杨晓岑, 李彪, 苏志虹, 陈晓丽. 超声心动图诊断冠心病心力衰竭患者心尖结构及功能的价值研究[J]. 心血管病防治知识, 2021, 11(18): 25-27.
[13]	彭纪龙. 超声心动图联合多排螺旋CT对复杂型先天性心血管病的诊断价值研究[J]. 心血管病防治知识, 2021, 11(17): 9-11.
[14]	王丽娜. 超声心动图在冠心病患者介入治疗前后的应用价值探讨[J]. 心血管病防治知识, 2021, 11(1): 19-21.
[15]	文成. 平衡法核素心血池显像测定右心室射血分数的应用价值及可行性分析[J]. 心血管病防治知识, 2021, 11(1): 25-27.