Study Of Right Heart Function For Chronic Thromboembolic Pulmonary Hypertension And After Ballon Pulmonary Angioplasty By Two-dimensional Speckle Tracking Echocardiography

Part I Evaluation of right heart function in patients with Chronic Thromboembolic Pulmonary Hypertension by Two-dimensional Speckle Tracking EchocardiographyObjective The strain parameters of right atrium,right ventricle and myocardium were measured by Two-dimensional Speckle Tracking Echocardiography to evaluate the right heart function of patients with CTEPH.Methods 40 CTEPH patients（CTEPH group）and 20 matched healthy people（control group）were collected.The myocardial strain parameters of RA were measured by2D-STE:RALS_pos,RALS_neg,RALS_totand RALSR;The structural and conventional functional parameters of RA were obtained by transthoracic echocardiography:RAS,RATEF,RAPEF,RAAEF,RASV,RAAEV,RAPEV and RVOTVTI.The volume parameters were corrected by body surface area to the corresponding index.The relationship between myocardial strain parameters of RA and structural and conventional functional parameters of right heart was analyzed.Results Compared with the control group,the RALS_tot,RALS_pos,and RALSR of the CTEPH group were significantly decreased（P<0.01）,and RATEF,RAPEF,RAAEF,and RAFi were also significantly decreased compared with the control group（P<0.01）,while RASVI and RAAEVI were significantly increased compared with the control group（P<0.01）.Comparison of the increased RA and RV in the CTEPH group with the increased RA and normal RV and the normal RA and RV groups,the RALS_totand RALS_poswere significantly decreased（P<0.05）;In the CTEPH group,no matter whether RA and RV increased or not,there were significant differences in RV routine function parameters and strain parameters compared with the control group（P<0.05）;RALS_totand RALS_poswere correlated with RAS,RALSR,RV routine function parameters and RV strain parameters（P<0.05）,and had a high correlation with RAFi,which reflected the overall function of RA（P<0.01）.Conclusion The RA myocardial strain parameters of CTEPH patients obtained by2D-STE have a good correlation with right heart structural parameters and right heart routine function parameters.RA myocardial strain parameters can better evaluate the right heart function of CTEPH patients.Part II Two-dimensional Speckle Tracking Echocardiography to evaluate right atrium function in patients with Chronic Thromboembolic Pulmonary Hypertension after Balloon Pulmonary AngioplastyObjective 2D-STE was used to study the changes of Right Atrium function after BPA in CTEPH patients,to evaluate the effect of surgery,and to determine the influencing factors of the effect of BPA.Methods A total of 18 CTEPH patients who received BPA were selected,and thoracic echocardiography was used to obtain preoperative and postoperative cardiac structural parameters and routine RA function parameters:IVCCI,RAS,RATEF,RAPEF,RAAEF,RAFi;2D-STE was used to obtain RA Strain parameters:RALS_pos,RALS_negand RALSR The changes of RA function,hemodynamics,serology and related clinical parameters before and after BPA operation were compared.Univariate Logistic regression was used to analyze all RA function parameters to study the factors that affect the surgical efficacy before BPA.Results After BPA in CTEPH patients,IVCCI increased,RAS decreased（P<0.05）,PASP,PADP,PAMP decreased（P<0.05）,RATEF,RALStot,RALSpos,RALSR increased（P<0.01）,RAFi increased（P<0.05）,cardiac NYHA grade decreased（P<0.05）,and 6 min walking distance increased（P<0.01）;univariate Logistic regression analysis revealed that the BPA preoperative RA functional parameters RATEF,RALS_tot,RALS_pos,and RALSR had an effect on the surgical efficacy.Conclusion RA function improved after BPA in CTEPH patients,PASP,PADP,PAMP decreased,suggesting that BPA can improve the right heart function in CTEPH patients,reduce pulmonary artery pressure in CTEPH patients,and determine the RA function parameters RATEF,RALS_tot,RALS_pos,RALSR are influencing factors for the outcome of BPA.