Evaluation On Changes Of Right Ventricular Function In Patients With OSAHS Before And After Treatment By Two-dimensional Speckle Tracking Imaging Combined With Real-time Three-dimensional Echocardiography

Objective To evaluate the structure and function of the right ventricle in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)by two-dimensional speckle tracking technology(2D-STI)combined with real-time three-dimensional echocardiography(RT-3DE).And to study the changes in the structure and function of the right ventricle after continuous positive airway pressure(CPAP)treatment for different lengths of time.Methods 50 patients with moderate and severe OSAHS diagnosed in our hospital based on medical history,physical signs and polysomnography(PSG)were selected as the study group,including 21 moderate patients and 29 severe patients.Another 40 healthy volunteers matched with the OSAHS group in age,gender and body mass index were selected as the control group.Basic clinical indicators such as age,sex,height,weight and blood pressure were recorded for all participants.Polysomnography,blood lipid examination,two-dimensional speckle tracking imaging,real-time three-dimensional echocardiography and traditional echocardiography were performed in patients with OSAHS before treatment,after 3 months of continuous treatment,after 6 months of continuous treatment and the control group.Right ventricular parameters were measured by traditional echocardiography: right ventricular end-diastolic diameter(RVDD),including right ventricular basal diameter(RVD1),right ventricular mid cavity diameter(RVD2),right ventricular longitudinal diameter(RVD3),right ventricular wall thickness(RVWT),tricuspid annular plane systolic excursion(TAPSE),peak systolic velocity of tricuspid annular(Sa),isovolumic systolic myocardial acceleration(IVA),late diastolic peak velocity(A),early diastolic peak velocity(E),deceleration time of peak E(DT)and pulmonary artery systolic pressure(SPAP).Right ventricular parameters were measured by real-time three-dimensional echocardiography: right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV),right ventricular end-diastolic volume index(RVEDVI),right ventricular end-systolic volume index(RVESVI),right ventricle Ejection fraction(RVEF).Right ventricular parameters were measured by two-dimensional speckle tracking imaging: right ventricular global longitudinal strain(RVGLS),right ventricular free lateral longitudinal strain(RVLLS),right ventricular septal longitudinal strain(RVSLS),basal segment of the right ventricular free lateral longitudinal strain(Basal RV-SL),media segment of the right ventricular free lateral longitudinal strain(Medial RV-SL),apical segment of the right ventricular free lateral longitudinal strain(Apical RV-SL).Results 1.Comparison of general data,PSG,and blood lipid results between the two groups There were no significant differences in age,BMI,SBP,and DBP between the two groups(P>0.05).AHI,minimum blood oxygen saturation(LSa O2)and time of blood oxygen saturation below 90%(Sa O2<90%)had statistical significance(P<0.05).There was no significant difference in total cholesterol(TC)and triglyceride(TG)between the two groups(P>0.05),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)were statistically significant(P>0.05).2.Comparison of right ventricular ultrasound measurement parameters between the two groups (1)Traditional echocardiography: There was no significant difference in the end-diastolic diameter of the right ventricle between the two groups(P>0.05).The RVWT of the OSAHS group was thicker than that of the control group.The TAPSE,Sa,IVA and E?A-1 of the OSAHS group were all lower than control group,DT and SPAP were higher than those in the control group,and the differences were statistically significant(P<0.05).(2)RT-3DE: There were statistically significant differences in RVEDV,RVESV,RVEDVI,RVESVI,RVEF between the two groups(P<0.05).(3)2D-STI:There were statistically significant differences in RVGLS,RVLLS,Basal RV-SL,Medial RV-SL,Apical RV-SL between the two groups(P<0.05),and there was no statistically significant difference in RVSLS(P>0.05).3.Correlation analysis RVEDV,RVESV,RVEDVI,RVESVI,RVGLS,RVLLS,Basal RV-SL,Medial RV-SL,Apical RV-SL,BMI,DT,SPAP were positively correlated with AHI,RVEF,TAPSE,E?A-1,IVA,Sa were negatively correlated with AHI,There is no correlation between RVSLS and AHI.Using AHI as the dependent variable and the above parameters as independent variables for multiple stepwise regression analysis,the results showed that Apical RV-SL,RVEF,RVGLS and RVESVI could be used as independent predictors of AHI.The standardized partial regression coefficient β were: 0.249,-0.305,0.253,0.246.4.Changes of PSG and blood lipid results in patients with OSAHS after CPAP treatment After 3 months of CPAP treatment,Sa O2<90% of the time decreased,AHI decreased,and LSa O2 increased,the differences were statistically significant(P<0.05).After 3 months of CPAP treatment,TC and LDL-C decreased,and the differences were statistically significant(P<0.05).There were statistically significant differences in blood lipid indexes between 6 months after CPAP treatment and before treatment,and the differences between 6 months after treatment and 3 months after treatment were statistically significant(P<0.05).5.Changes of right ventricular ultrasound measurement parameters in patients with OSAHS after CPAP treatment (1)Traditional echocardiography: E?A-1,SPAP,DT after 3 months CPAP treatment and after 6 months of treatment compared with before treatment differences were statistically significant(P<0.05).IVA was also significantly improved after 6 months of treatment,and the differences SPAP and IVA between after 6 months treatment and 3 months treatment were also statistically significant(P<0.05).(2)RT-3DE: There were statistically significant differences in RVEDV,RVESV and RVESVI after 3 months of treatment compared with before treatment(P<0.05).The differences each parameter between after 6 months of treatment and before treatment were statistically significant(P<0.05).And the differences between 6 months and 3 months after treatment were statistically significant(P<0.05).(3)2D-STI: After 3 months of treatment,RVGLS,RVLLS,Apical RV-SL were significantly different from those before treatment(P<0.05).After 6 months of treatment,RGLLS,RVLLS,Basal RV-SL,Apical RV-SL were significantly different from those before treatment(P<0.05).And the differences RVLLS and Apical RV-SL between after 6 months of treatment and after 3 months treatment were statistically significant(P<0.05).6.Comparison of effects after treatment in patients with moderate and severe OSAHS Four indicators RVEF,RVESVI,Apical RV-SL,and RVGLS,which were highly correlated with AHI,were selected.The analysis found that patients with severe OSAHS benefited more than patients with moderate OSAHS after 6 months of CPAP treatment.Conclusions 1.Abnormal structure and function of right ventricle in patients with OSAHS.2.After 3 months of CPAP treatment in OSAHS patients,the right ventricular function improved to some extent,and after 6 months of CPAP treatment,the right ventricular function was further recovered.3.2D-STI and RT-3DE can accurately evaluate the structure and function changes of right ventricle in OSAHS patients,and the three-dimensional volume and speckle strain parameters were well correlated with AHI.4.CPAP treatment can improve dyslipidemia in patients with OSAHS.