目的:应用三维容积定量分析联合二维斑点追踪技术(two-dimensional speckle-tracking imaging,2D-STI)评价心房颤动(atrial fibrillation,AF)患者中功能性三尖瓣反流(functional tricuspid regurgitation,FTR)患者的右室功能。方法:选取80例AF患者,根据三尖瓣反流程度分为非显著FTR组(A组)40例、显著FTR组(B组)40例,另选取正常对照组(C组)35例。比较三组临床数据和经胸超声心动图参数以及右室功能参数,探寻AF不同程度的FTR右心功能的差异,为临床预测右室功能提供相应的依据。结果:三组右心房内径(right atrial diameter, RAD)和右心室内径(right ventricular diameter, RVD)相比差异有统计学意义(P＜0.05);三组右心室射血分数(right ventricular ejection fraction,RVEF)、右心室整体纵向应变(right ventricular global longitudinal strain, RVGLS)绝对值相比,B组最小,A组其次,C组最高,差异有统计学意义(P＜0.05);三组右室面积变化分数(fraction of right ventricular area change, RVFAC)、右室心肌工作指数(Tei指数)、三尖瓣环平面收缩位移(tricuspid annular plane systolic excursion, TAPSE)相比差异有统计学意义(P＜0.05));三尖瓣环收缩期峰值流速(tricuspid annular peak systolic velocity, TAPSV)(S')三组相比差异无统计学意义(P＞0.05);经Pearson相关性分析,Tei指数、RVD及房颤时间与反流面积呈正相关,TAPSE、FAC、RVGLS绝对值及RVEF与反流面积呈负相关,差异均有统计学意义(P＜0.05)。结论:非显著FTR组右心功能已经受损,且随着FTR程度增加,右心室受损进一步加重,右室三维容积定量分析联合2D-STI技术能够评估AF患者中FTR的右心室整体收缩功能,从而为临床诊疗及预后评价提供一定的价值。
Objective:To evaluate right ventricular function in patients with atrial fibrillation (AF) and functional tricuspid regurgitation (FTR) using three-dimensional volumetric quantitative analysis combined with two-dimensional speckle tracking imaging (2D-STI). Methods: Eighty AF patients were selected and divided into the non-significant FTR group (group A, n=40) and the significant FTR group (group B, n=40) according to the degree of tricuspid regurgitation. A total of 35 normal people were selected as the control group. The clinical data and transthoracic echocardiography parameters and right ventricular function parameters of the three groups were compared to explore the differences in right ventricular function of patients with different degrees of AF and FTR, and to provide the basis for clinical prediction of right ventricular function. Results: Differences in right atrial diameter (RAD) and right ventricular diameter (RVD) of the three groups were statistically significant (P＜0.05). Compared among the three groups on absolute value of RVEF and RVGLS, group B had the smallest values, group A was the second, group C was the highest, and the difference was statistically significant (P＜0.05). Differences in fraction of right ventricular area change (RVFAC), Tei, and tricuspid annular plane systolic excursion (TAPSE) of the three groups were statistically significant (P＜0.05). Differences in tricuspid annular peak systolic velocity (TAPSV) (S') of the three groups was not statistically significant (P＞0.05). Pearson correlation analysis showed that Tei index, RVD, and atrial fibrillation time were positively correlated with the area of regurgitation (r= 0.411, 0.327, 0.245) (P＜0.05), TAPSE, FAC, RVGLS absolute value and RVEF were negatively correlated with the area of regurgitation (r=-0.542, -0.518, -0.719, -0.705) (P＜0.05). Conclusion: The right ventricular function of the non-significant FTR group (group A) has been damaged, and the right ventricular damage is further aggravated with the aggravation of FTR. The three-dimensional volume quantitative analysis of the right ventricle combined with 2D-STI can effectively evaluate the right ventricular systolic function of AF patients with FTR, which could provide basis for clinical diagnosis and prognosis.
[1] Prihadi EA, van der Bijl P, Dietz M, et al. Prognostic implications of right ventricular free wall longitudinal strain in patients with significant functional tricuspid regurgitation[J]. Circ Cardiovasc Imaging, 2019, 12(3): e008666.
[2] Bannehr M, Kahn U, Liebchen J, et al. Right ventricular longitudinal strain predicts survival in patients with functional tricuspid regurgitation[J]. Can J Cardiol, 2021, 37(7): 1086-1093.
[3] Hassanin M, Ong G, Connelly KA. Right ventricle longitudinal strain: a new tool in functional tricuspid regurgitation prognostication[J]. Can J Cardiol, 2021, 37(7): 945-948.
[4] January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J]. J Am Coll Cardiol, 2014, 64(21): e1-76.
[5] Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2014, 63(22): e57-185.
[6] 中国医师协会超声医师分会心脏超声专业委员会,中国医师协会心血管病分会结构性心脏病专业委员会. 三尖瓣反流介入治疗的超声心动图评价中国专家共识(2021版)[J]. 中华超声影像学杂志, 2021, 30(6): 461-471.
[7] Kornej J, Seewöster T. Left atrial size and function as markers of AF progression and outcomes[J]. Int J Cardiol, 2019, 294: 41.
[8] Ji MM, Wu WQ, He L, et al. Right ventricular longitudinal strain in patients with heart failure[J]. Diagnostics(Basel), 2022, 12(2): 445.
[9] Reddy YNV, Obokata M, Verbrugge FH, et al. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation[J]. J Am Coll Cardiol, 2020, 76(9): 1051-1064.
[10] Nishimura S, Izumi C, Yamasaki S, et al. Impact of right ventricular function on development of significant tricuspid regurgitation in patients with chronic atrial fibrillation[J]. J Cardiol, 2020, 76(5): 431-437.
[11] Houard L, Militaru S, Tanaka K, et al. Test-retest reliability of left and right ventricular systolic function by new and conventional echocardiographic and cardiac magnetic resonance parameters[J]. Eur Heart J Cardiovasc Imaging, 2021, 22(10): 1157-1167.
[12] Li YM, Wang T, Haines P, et al. Prognostic value of right ventricular two-dimensional and three-dimensional speckle-tracking strain in pulmonary arterial hypertension: superiority of longitudinal strain over circumferential and radial strain[J]. J Am Soc Echocardiogr, 2020, 33(8): 985-994.e1.
[13] Cittar M, Cipriani A, Merlo M, et al. Prognostic significance of feature-tracking right ventricular global longitudinal strain in non-ischemic dilated cardiomyopathy[J]. Front Cardiovasc Med, 2021, 8: 765274.
[14] Nishimura S, Izumi C, Yamasaki S, et al. Impact of right ventricular function on development of significant tricuspid regurgitation in patients with chronic atrial fibrillation[J]. J Cardiol, 2020, 76(5): 431-437.
