Sri Technical Evaluation Of Pulmonary Thromboembolism In Patients With Right Ventricular Function And Clinical Significance

Objective:To observe the changes of right ventricular long-axis strain and strain rate in patients with pulmonary thromboembolism after right ventrieular pressure overload and the effect on left ventrieular fuction,finally to search possibly useful parameters to judge right ventricular dysfunction.Methods:47 patients with PTE and 33 healthy volunteers matched with age and sex were studied. In a accordance with pulmonary arterial systolic pressure(PASP) further division. APE mild group included 8 patients;APE moderate group included 10 patients;APEsevere group included 7 patients; CTEPH mild group included 7 patients;CTEPH moderate group included 10 patients;CTEPH severe group included 5 patients; the standard apical four-chamber view were acquired by 2D and then switched to TVI mode.Firstly,the right ventricular end-diastolic diameter.ritio of right to left ventricular end-diastolic diameter and ritio of right to left atrialtissue end-systolic diameter were measured.Secondly, the image of tricuspid, mitralinflow and tricuspid regurgitation was obtained and early diastolic peak flow velocity(E), late diastolic peak flow velocity(A)and E/A ratio were measured by using pulse ultrasonic wave Doppler technique.Pulmonary arterial systolic pressure(PASP) was measured by using continuous ultrasonic wave Doppler technique. Right ventricular ejection fraction(RVEF)was obtained by.Finally.In TVI pattern, peak systolic strains (S),peak systolicst strain rates (SRs) at the basal, mid and apical segment of RV free wall and septal were quantitatively measured by using SRI software system.and then analysis.Results:①RVTD/LVTD.RATD/LATD,E and E/A ratio of tricuspid inflow imaging were significantly different between patients with PTE and normal controls.②Age and sex had little influence on the right ventricular myocardia strain and strain rate in normal subjects.③The APE mild group could result in the increased srain and strain rate in basal and mid segment of RV freewall, but there were not significant difference with the normal subjects.The moderate group could result in the increased systolic strain and strain rate from basal to mid segment of RV reactively,as well as the decreased diastolic fuction of LV. The severe group could result in the significantly decreased srain and strain rate from basal to mid segment,and the middle segment of RV freewall was most significant among them.Also the diastolic function of LV and RV were impaired.④Patients in CTEPH group had worse RV performance parameters than those of the controls.Peak systolic strain and strain rate were significantly impaired in patients with CTEPH compared with controls. The more increasing of PASP,the more impairing of RV systolic fuction. Conclusions:①Patients with pulmonary thromboembolism exist different degree of reduction in right ventricular function.②Different degrees of pulmonary artery pressure in patients with elevated right ventricular systolic function PTE different, and with the increase of pulmonary artery pressure to reduce.③Patients with PTE with reduced right ventricular function also affects the left ventricular diastolic filling, with the increase of pulmonary arterial pressure, left ventricular filling abnormalities.④Strain, strain rate sensitivity of the load change after better-than-normal ejection fraction index, can accurately estimate the PTE patients with right ventricular long-axis systolic function, the formulation of treatment, observation and assessment of treatment outcome has important clinical significance.