| Application of echocardiography in assessment of right ventricular function in normal subjects and patients with idopathic pulmonary hypertensionObjective:Pulmonary arterial hypertension(PAH)is a kind of pulmonary circulation hypertension.It is a group of pathophysiological syndrome characterized by pulmonary vascular resistance and pulmonary artery systolic pressure(PASP).In recent years,researchers have found that the right ventricle plays an important role in maintaining hemodynamics,so they pay more attention to it.At present,there are many methods to evaluate the right ventricular function,such as right heart catheterization,echocardiography and so on.In contrast,echocardiography is not only safe and convenient,but also cheap,which has become the first choice in clinical examination.The purpose of this study was to compare the value of real-time echocardiography and echocardiography in patients with idiopathic pulmonary hypertension.Methods:120 patients with idiopathic pulmonary hypertension in our hospital from January 2019 to February 2022 were selected.Another 40 healthy people in the same period were selected as the healthy control group.Echocardiography was used to measure the structural parameters of the right heart,including transverse diameter(LVTD),transverse diameter(RVTD),tricuspid annular systolic velocity(TAPSE),Tei index,peak systolic velocity(S’)Stroke volume(SV)and PASP,right ventricular output(RCO),pulmonary artery diastolic pressure(DPAP),and mean pulmonary artery pressure(MPAP).end systolic volume(ESV)were measured by RT-3DE.The differences of right ventricular structure parameters and hemodynamic parameters between pH group and healthy control group were compared.Results:1.The RVTD,EDV and ESV of PAH group were higher than those of healthy group(P<0.05),while LVTD,SV and RVEF of PAH group were lower than those of healthy control group(P<0.05).2.The SPAP,DPAP and MPAP of the two groups were compared.The healthy control group was lower than the pH group,while the RCO was higher than that of the PAH group(P<0.05).3.40 healthy controls were evaluated by conventional ultrasound and RT-3DE.The s’ of tricuspid annulus measured by Tissue Doppler imaging(TDI)and Tei index at tricuspid annulus of right ventricular free wall were significantly correlated with RVEF measured by RT-3DE.There was also a significant correlation between TAPSE measured by M-mode echocardiography and RVEF measured by RT-3DE.Conclusions:Right ventricular patients idiopathic is decreased,and echocardiography can evaluate the cardiac function of these patients.Evaluation of right ventricular function in patients with different degrees of idopathic pulmonary hypertension by echocardiographyObjective:Based on patients with IP AH patients can be divided into mild,medium,and severe IP AH patients with different degree of right heart function to reduce,be ware of impaired to a certain extent and cannot compensate for the impaired by itself,will be the emergence of secondary myocardial hypertrophy and ventricular enlargement,reduced left ventricular ejection fraction and so on,with right heart failure in the end.In the first part,we use the echocardiography of right heart function in patients with IP AH is evaluated,and found that it has good application value,on this basis we continue using echocardiography of right heart function in patients with different degree of pulmonary hypertension,discuss its value of patients with IP AH play a guide role.Methods:120 patients with idiopathic pulmonary hypertension admitted to our hospital from January 2019 to February 2022 were selected.According to pulmonary arterial systolic blood pressure,120 patients were divided into mild patients(40 patients),moderate patients(52 patients)and severe patients(28 patients).Echocardiography was used to measure the structural parameters of the right heart,diameter(LVTD),transverse diameter(RVTD),tricuspid annular systolic velocity(TAPSE),Tei index,peak systolic velocity(S’),stroke volume(SV)and PASP,right ventricular output(RCO),pulmonary artery diastolic pressure(DPAP),and mean pulmonary artery pressure(MPAP).right ventricular(ESV)were measured by RT-3DE.The differences in the parameters related to the right heart structure and hemodynamic parameters of patients with different degrees of IPAH were compared.Results:1.Compared the relevant parameters of right heart structure in patients with mild,moderate and severe IP AH,among which RVTD,EDV and ESV parameters in patients with moderate and severe PAH were higher than those in patients with mild PAH,while LVTD,SV and RVEF were lower than those in patients with mild PAH(P<0.05).2.In terms of SPAP,DPAP and MPAP,moderate and severe PAH patients were all higher than those in the mild PAH group,with statistically significant differences(P<0.05).3.In terms of DPAP and MPAP indexes,there was no significant difference between patients in the moderate PAH group and those in the severe PAH group(P>0.05);RCO showed an decreasing trend among patients of mild PAH group,moderate PAH group and severe PAH group(P<0.05).4.Conventional ultrasound and RT-3DE were used to evaluate 28 patients with severe PH.The tricuspid annulus S’ measured under TDI,the Tei index at the tricuspid annulus of the free wall of the right ventricle,and the TAPSE measured by M-mode echocardiography have good correlation with the RVEF measured by RT-3DE.Conclusions:1.With the increase of systolic blood pressure(PASP),volume increased gradually;2.The use of echocardiography can well measure the right heart function of patients with different degrees of idopathic pulmonary hypertension,which is conducive to the decision making of clinical intervention.Analysis of the effect and influencing factors of sildenafil in the tr eatment of idopathic pulmonary arterial hypertensionObjective:To investigate the effect of sildenafil pulmonary arterial hypertension(IPAH),and to analyze the related factors affecting the clinical effect.Methods:120 patients with IP AH admitted to our hospital from January 2019 to February 2022 were selected as the observation objects.All patients were treated with sildenafil.The efficacy was evaluated after 6 months of treatment.The patients were divided into the effective group and the ineffective group.The general data,clinical laboratory indexes,echocardiographic parameters and right cardiac catheter parameters of the two groups were analyzed and compared.Logistic regression analysis was used to analyze the influencing factors of the effect of sildenafil treatment.Results:Of the 120 patients with IP AH treated with sildenafil,75 were effective,the effective rate was 62.50%,45 were ineffective,and the ineffective rate was 37.50%.smoking,drinking,hypertension,chronic kidney disease,anemia,WHO cardiac function classification,RVTD,LVTD,EDV,ESV,SV,RVEF,6MWD,NT proBNP and SPAP between the effective and ineffective groups(P>0.05);The proportion of ineffective combination with diabetes was higher than that of effective group,and the time from symptom to diagnosis was longer than that of effective group(P<0.05);RAP and PVR in the ineffective group were higher than those in the effective group,and SaO2,SVO2 and CI were lower than those in the effective group(P<0.05).Multivariate regression analysis was conducted for the risk factors with statistically significant differences in the results of univariate analysis,that is,with diabetes,time from symptom to diagnosis,RAP,PVR,SaO2,SVO2 and CI as independent variables,and with effective or ineffective treatment as dependent variables,the model was included and multivariate logistic regression analysis was conducted.The results showed that SVO2 was a protective factor for the efficacy of sildenafil before treatment(OR=0.481),Diabetes mellitus(OR=285.256),the time from symptom to treatment(OR=1.842),and RAP(OR=1.786)were the risk factors for the efficacy of sildenafil(P<0.05).Conclusion:The use of sildenafil in the treatment of IP AH patients has a certain effect,but at the same time,it should be noted that the efficacy of patients with diabetes,symptoms to treatment time and relatively large RAP may be affected.Therefore,it is necessary to actively correct blood glucose,and early diagnosis and active treatment are expected to further improve the prognosis of patients. |
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