| Objective and backgroundCor Pumanale is a abbreviation of chronic pulmonary heart disease,it is showed that the chronic diseases of thorax and pulmonary artery cause the resistance of pulmonary circulation to be raised up,resulting in pulmonary hypertension and right ventricular hypertrophy,accompanying or unaccompanying right heart failure.It's constituent ratio was 38.5～46.0%in cardiac diseases which were in hospital.It was a commonly encountered disease,it's average morbidity was 0.48%,It's fatality rate was about 15%,it was estimated that 25 million patients were suffered the disease, and 30%patients were belonged to unsmoking crowd,it occured most frequently in female sexes of rural areas,the factors of individual impression,hereditary,airflue high reactivity,environment,profession,chemical substances and air pollution were intimately interrelated with onset.From pathological changes to see,besides the structure changes of bronchus and lung,the major changes of heart structure included right ventricular incrassation,chambers of heart expansion,pulmonary artery taper bulge,hypertrophy,cardiac fiber atrophy and mesenchymal edema,focal necrosis, and then the muscle tissue of heart was replaced by fibrous tissue.As to the possibale changes of cardiac functions resoulted from right ventricular hypertrophy,Rosu pointed out that in the course of pathological evolvement of myocardium hypertrophy,cardiac functions could be changed as follows:myocardial function changed from initial adaptation to pathology,and then,because myocardium were constantly influnced,firstly it's distolic functions and secondly it's systolic functions were damaged,finally congestive heart failure were resulted in.But to want to factly quntitativly estimate whether right ventricular systolic and distolic functions had been impaired and their degrees,to use traditional two dimension echocardiography and hemodynamics methods to measure,the results would be influnced by many factors,the specificity and sensibility would be all lower.In recent years,as high frame frequency(≥70 frames per second)tissue Doppler imaging technology appeared,it had been a more effective methods to quantitatively anlayze overall and regional myocardial functions,the technology mainly quantitatively assessed the motion of longitudinal muscle which occupied 70%myocardium (including mesurement of tissue velocity,displacement,strain,strain rate,time to peak velocity).The project mainly measured the parameters of local myocardial motion of basal,mid and apical segments of right ventricular anterior,inferior and lateral walls,to desire to get some informations of myocardial dynamics aspects such as length,velocity et al,furthermore,to judge if regional myocardial systolic and diastolic functions in Cor Pumanale had been impaired,and to explore if the measurements of tissue Doppler parameters of every segments may indirectly reflect the damage of the global systolic or diastolic functions of right ventricular,which position and which indices will have more values in estimating cardiac functions of right ventricular walls in Cor Pumanale.Materials and Methods1.Object of StudyThe patients with Cor Pumanale were 52 cases,among the patients,25 cases were male,27cases were female,the ages were from 51 to 93,average ages were 71.98±8.89.All of patients with Cor Pumanale had histories of chronic bronchitis and chronic obstructive emphysema,the diagnosis was corresponded with clinic diagnostic standard of Cor Pumanale.The patients had no histories of hypertension and coronary heart disease,and didn't show serious arrhythmia such as auricular fibrillation et al by electrocardiogram diagnosis.There were 53 cases in normal group selected from crowds of physical examination,in the group,the male were 26 cases, the female were 27 cases,ages were from 62 to 89,the average ages were 72.82±7.37.The patients had no histories of hypertension and other heart diseases et al.; patients had no any discomfort and abnormity by examination of echocardiography, X-ray,and electrocardiogram.2.Apparatus and MethodsColor Doppler ultrasonic diagonstic apparatus produced by General Electric corporation of USA was used.The quantitative analysis softwares of tissue Doppler imaging including quantitative tissue velocity imaging(QTVI),tissue tracking imaging(TTI),tissue synchronization imaging(TSI),strain imaging(SI),strain rate imaging(SRI)were deployed in the apparatus.The M3S surface array probe was used, it's frequency was 1～3 MHz.The horizontal position or left lateral position were adopted to examine,the apical four chamber view and apical two chamber view were exposed,the right ventricular ejection fractions(RVEF)were measured by biplane methods,and then anterior-inferior-lateral walls were displayed respectively,three integrated cardiac cycles imagings were dynamicly stored on the condition of tissue velocity imaging(TVI),the samples were put in subendocardial layers of levels of basal,mid and apical segments of the walls,the curves of myocardial tissue velocity, displacement,strain,strain rate of the samples were synchronously recoreded on the models of TVI,TTI,SI,SRI.the average peak systolic velocity(APVs),early diastolic velocity(Ve),late diastolic or atrial systolic velocity(Va),peak systolic displacement(PDs),time-to-peak velocity(TTP),peak systolic strain(PSs),peak systolic strain rate(PSRs),early diastolic strain rate(Esr),late diastolic strain rate(Asr) were measured in each curve;the mesurements of three cardic cycles were averaged, and the Ve/Va,Esr/Asr were caculated.On the condition of tissue Doppler imaging(TDI),the Ve and Va of outer anulus of tricuspid valve in apical four chamber view were measured,and the rates of measurements of Ve,Va of tricuspid valve anulus(TVA-Ve/Va)were caculated.3.Statistics HandlingThe datae were analyzed by SPSS 14.0 statistic software,all of measurement datae were showed by mean±standard deviation.The same parameters of same position between Cor Pumanale group and normal group were compared by t test of unitizing data,the dividing values of parameters which were significantly different from normal group were defined by receiver operating characteristic curves(ROC).The linear correlations were analyzed between every systolic parameters (including APVs,PDs,PSs,PSRs)of each segments of right ventricular walls in Cor Pumanale and RVEF;The linear correlations were analyzed between every diastolic parameters(including Ve,Va,Ve/Va;Esr,Asr,Esr/Asr)of each segments of right ventricular walls in Cor Pumanale and TVA-Ve/Va.All of measurements of the parameters among different segments of same walls were assessed by one-way analysis of variance(One-Way ANOVA)firstly;if the difference of parameters were significant,the parameters were gone on to be compared by Newman-Keuls test(q test),theαvalue was equaled to 0.05 as the size of a test.Results.1.The measurements of APVs,PDs,TTP,PSs,PSRs of every segments' myocardium of right ventricular walls were compared between Cor Pumanale group and normal group.In Cor Pulmonale group,the means of PSs in all segments of right ventricular walls were less than those in normal group(P＜0.05).The means of PDs in basal segments of anterior,inferior,lateral walls and in mid segments of anterior walls were less than those in normal group(P＜0.05).The means of PSRs in basal,mid segments of anterior walls and in apical segments of lateral walls were less than those in normal group(P＜0.01).Except measurement of apical segment in lateral walls(P＜0.05),there were no significant differences for the means of TTP of most of segments between Cor Pumanale group and normal group(P＞0.05);there were no significant differences for the means of APVs of all of segments between Cor Pumanale group and normal group(P＞0.05).2.The measurements of Ve,Esr,Va,Asr,Ve/Va,Esr/Asr of every segments' myocardium of right ventricular walls were compared between Cor Pumanale group and normal group.In Cor Pumanale groups,the means of Ve in basal,mid segments of anterior walls and basal segments of inferior,lateral walls were less than those in normal group(P＜0.05).Except measurement of apical segments in inferior walls(P＜0.05), there were no significant differences for the means of Va of most of segments between Cor Pumanale group and normal group(P＞0.05);the means of Ve/Va in basal,mid segments of anterior walls and apical segments of inferior walls were less than those in normal group(P＜0.05)..In Cor Pumanale group,the means of Esr in basal,mid segments of anterior walls and mid,apical segments of lateral walls were less than those in normal group(P＜0.05).there were no significant differences for the means of Asr of all of segments between Cor Pumanale group and normal group(P＞0.05).Except measurement of mid segments in anterior walls(P＜0.05),there were no significant differences for the means of Esr/Asr of most of segments between Cor Pumanale group and normal group(P＞0.05).3.In Cor Pumanale group,the linear correlations were analyzed between every systolic parameters(including APVs,PDs,PSs,PSRs)of each segments of right ventricular walls and RVEF;The linear correlations were analyzed between every diastolic parameters(including Ve,Va,Ve/Va;Esr,Asr,Esr/Asr)of each segments of right ventricular walls and TVA—Ve/Va.In Cor Pumanale group,there were positive linear correlations between the measurements of PSs of all of segments of right ventricular walls,PSRs of basal and mid segments of anterior walls,PDs of basal segments of anterior and inferior walls and the measurements of RVEF,the r values were 0.20～0.85,P＜0.05,among them, the line correlations of PSs of basal segments of anterior was highest,the r value was 0.85,P＜0.001,the regression equation was Y=0.86X+35.09,But there were no linear correlation for APVs,TTP of all of segments of right ventricular walls(P＞0.05).There were linear correlations between mesurementsof Esr,Asr,Ve of part1 of segments of right ventricular walls,Esr/Asr,Ve/Va,Va of all of segments of right ventricular walls and the measurements of TVA-Ve/Va,the r values were 0.21～0.68,P＜0.05,among them,the line correlations of Ve/Va of basal segments of inferior walls was highest,the r value was 0.68,the regression equation was Y=0.47X+0.21.4.The sensitivities,specificities,accuracy rates of diagnostic dividing values of parameters in Cor Pumanale group which were significantly different from normal group were defined by ROC.In Cor Pumanale group,the specificities of diagnostic dividing values of most of parameters of significant difference from normal group were all higher by ROC curves,except Ve in basal segments of anterior walls and Esr in mid segments of lateral walls were slightly lower for 58.0%.the sensitivities of diagnostic dividing values of the parameters for PSs,PDs, PSRs,Ve in basal segments of anterior walls,PSs,PSRs,Esr,Esr/Asr in mid segments of anterior walls,Esr in mid segments of lateral walls,PSs,Esr in apical segments of lateral walls and PSs in mid,apical segments of inferior walls were all higher(＞60%).The accuracy rates of PDs of mid segments of anterior walls and basal segments of inferior walls,PSRs of mid segments of inferior walls,Ve of basal segments of lateral and inferior walls,Va of apical segments of ingerior walls,Esr of basal segments of anterior walls were moderate(50%～60%),the accuracy rates of the other parameters were higher(＞60%).4.All of means of the parameters among different segments of same walls were assessed by One Way ANOVA firstly;if the differences of means were significant,the means were gone on to be compared by q test,the statistical results of two group were compared.In Cor Pumanale group,the differences of overall means of PSs,PSRs,Ve/Va, Asr among every segment in anterior walls were not similar to those in normal group; the differences of overall means of Ve/Va,Esr/Asr,Asr among every segment in lateral walls were not similar to those in normal group;the difference of overall mean of Asr of among every segment in inferior walls was not similar to that in normal group;the differences of overall means of the other parameters among every segment in each wall were similar to those in normal group.Conclusions1.The regional systolic functions of each segment of right ventricular walls in patients with Cor Pumanale were impaired was fistly found in this study.2.The regional diastolic functions of most of segments of right ventricular walls in patiens with Cor Pumanale were impaired was found in the study.3.The regional cardiac insufficiency of right ventricular walls can be estimated quantitatively in patiens with Cor Pumanale.The reference diagnostic standards are firstly put forward in the study.Among them,if the dividing value of PSs of basal segment of inferior wall is -22%,it's diagnostic value will be higher to diagnose regional systolic insufficiency,it's sensitivity,specificity and accuracy rate were 72.54%,65.38%,68.92%respectitvely.If the dividing value of Esr/Asr of mid segment of anterior wall is 0.82,it's diagnostic value will be higher to diagnose regional diastolic insufficiency,it's sensitivity,specificity and accuracy rate were 72.00%,62.00%,65.05%respectitvely.4.The researchs of comparison analysis of many tissue Doppler technologies were fistly used to eveluate regional cardiac functions of right ventricular walls in patients with Cor Pumanale in the study.Among them,the PSs is the best evaluation index for estimating regional systolic insufficiency,the Ve,Esr are the most important evaluation indices for estimating regional diastolic insufficiency.5.The global systolic or diastolic functions of right ventricular in patients with Cor Pumanale can be estimated by measurements of tissue Doppler parameters of regional myocardium was firstly put forward in the study,among parameters,it is valuable indices for PSs of basal segment of anterior wall and Ve/Va of basal segment of inferior wall to eveluate overall systolic or diastolic functions of right ventricular respectively.6.The anterior wall of right ventricular is the most important wall,and the basal segment of every wall of right ventricular is the most important segment,when the regional myocardial functions are evaluated by tissue Doppler imaging was fistly found in the study.
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