标题：右心声学造影定量分析技术评价肺心病患者右心室收缩功能对预后的预测效能

      作者：王丹，刘璐，柳仕博，魏云，李威震    王丹，刘璐，柳仕博，魏云，李威震郑州大学第一附属医院超声科，河南 郑州 450052

      卷次： 2024年35卷14期

      【摘要】 目的 探讨右心声学造影定量分析技术评价肺源性心脏病(简称“肺心病”)患者右心室收缩功能对预后的预测效能。方法 前瞻性选取2020年4月至2022年12月郑州大学第一附属医院收治的113例肺心病患者，根据治疗后6个月内是否发生主要不良心血管事件(MACE)分为预后不良组30例和预后良好组83例。比较两组患者的临床资料及右心室收缩功能指标[右心室收缩末期容积(RVESV)、右室舒张末容积(RVEDV)、右室每搏量(RVSV)、右室射血分数(RVEF)]、右心声学造影定量参数[时间常数(K)、三尖瓣环收缩期峰值速度(Vs)、峰值强度减半时间(HT)、平均通过时间(MTT)]，采用Pearson相关系数分析各定量参数与右心室收缩功能指标的相关性，采用受试者工作特征曲线(ROC)评价各参数单独及联合应用对预后的预测效能。结果 预后不良组患者的RVESV、RVEDV分别为(58.35±8.42) mL、(84.56±13.97) mL，明显高于预后良好组的(43.77±6.17) mL、(64.50±10.48) mL，RVSV、RVEF分别为(20.61±3.80) mL、(40.48±5.22)%，明显低于预后良好组的(25.87±5.29) mL、(48.10±6.35)%，差异均有统计学意义(P<0.05)；预后不良组患者的K、Vs分别为(0.23±0.07)、(3.19±1.06) cm/s，明显低于预后良好组患者的(0.41±0.13)、(4.86±1.61) cm/s，HT、MTT分别为(42.77±10.21) s、(72.15±18.93) s，明显长于预后良好组患者的(25.52±7.33) s、(48.07±10.67) s，差异均有统计学意义(P<0.05)；经Pearson相关系数分析结果显示，K、Vs与RVESV、RVEDV呈负相关 (r=-0.625、-0.618，-0.651、-0.642)，与 RVSV、RVEF 呈正相关 (r=0.639、0.707，0.650、0.619)，HT、MTT 与RVESV、RVEDV呈正相关(r=0.636、0.665，0.704、0.629)，与RVSV、RVEF呈负相关(r=-0.628、-0.641，-0.652、-0.701)(P<0.05)；ROC分析结果显示，K、Vs、HT、MTT预测肺心病患者预后的曲线下面积(AUC)分别为 0.843、0.750、0.767、0.838，敏感度分别为80.00%、83.33%、73.33%、80.00%，特异度分别为77.11%、60.24%、75.90%、81.93%，联合预测预后的AUC为0.945，敏感度为90.00%，特异度为86.75%；K、Vs低值的肺心病患者预后不良风险分别是高值患者的6.512倍、4.741倍，HT、MTT高值的肺心病患者预后不良风险分别是低值患者的4.648倍、7.590倍，差异有统计学意义(P<0.05)。结论 右心声学造影定量参数K、Vs、HT、MTT与肺心病患者右心室收缩功能及预后有关，可作为临床评估预后情况的有效检查方式之一。
      【关键词】 肺源性心脏病；右心声学造影；定量分析；右心室收缩功能；预后；预测效能
      【中图分类号】 R541.5 【文献标识码】 A 【文章编号】 1003—6350（2024）14—2050—06

Effect of evaluating right ventricular systolic function by quantitative analysis of right heart contrast echocar-diography in patients with pulmonary heart disease for predicting prognosis.
WANG Dan, LIU Lu, LIU Shi-bo, WEIYun, LI Wei-zhen. Department of Ultrasound, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,Henan, CHINA
【Abstract】 Objective To explore the prognostic efficacy of evaluating right ventricular systolic function in pa-tients with pulmonary heart disease ("cor pulmonale") by quantitative analysis of right heart contrast echocardiography.Methods A prospective study was conducted to select 113 patients with pulmonary heart disease admitted to the FirstAffiliated Hospital of Zhengzhou University from April 2020 to December 2022. They were divided into a poor progno-sis group of 30 patients and a good prognosis group of 83 patients based on whether major adverse cardiovascular events(MACE) occurred within 6 months after treatment. The clinical data and right ventricular systolic function indicators[right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV), right ventricularstroke volume (RVSV), right ventricular ejection fraction (RVEF)], quantitative parameters of right heart contrast echo-cardiography [time constant (K), tricuspid annular systolic peak velocity (Vs), peak intensity halving time (HT), meantransit time (MTT)] were compared between the two groups. Pearson correlation analysis was used to analyze the correla-tion between each quantitative parameter and right ventricular systolic function indicators, and receiver operating charac-teristic (ROC) curve was used to evaluate the predictive efficacy of each parameter alone and in combination for progno-sis. Results The RVESV and RVEDV in the poor prognosis group were (58.35±8.42) mL and (84.56±13.97) mL, re-spectively, which were significantly higher than (43.77±6.17) mL and (64.50±10.48) mL in the good prognosis group;the RVSV and RVEF were (20.61 ± 3.80) mL and (40.48 ± 5.22)% , respectively, which were significantly lower than(25.87±5.29) mL and (48.10±6.35)% in the good prognosis group; the differences were statistically significant (P<0.05).The K and Vs in the poor prognosis group were 0.23±0.07, (3.19±1.06) cm/s, which were significantly lower than 0.41±0.13, (4.86±1.61) cm/s in the good prognosis group; the HT and MTT were (42.77±10.21) s and (72.15±18.93) s, respec-tively, which were significantly longer than (25.52±7.33) s and (48.07±10.67) s in the good prognosis group; the differ-ences were statistically significant (P<0.05). Pearson correlation analysis showed that K and Vs were negatively correlat-ed with RVESV and RVEDV (r=-0.625, -0.618, -0.651, -0.642), while positively correlated with RVSV and RVEF (r=0.639, 0.707, 0.650, 0.619), all P<0.05; HT and MTT were positively correlated with RVESV and RVEDV (r=0.636,0.665, 0.704, 0.629), but negatively correlated with RVSV and RVEF (r=-0.628, -0.641, -0.652, -0.701), all P<0.05.ROC curve analysis showed that the area under the curve (AUC) of K, Vs, HT, and MTT for predicting the prognosis ofpatients with pulmonary heart disease were 0.843, 0.750, 0.767, and 0.838, with sensitivities of 80.00% , 83.33% ,73.33%, and 80.00%, respectively and specificities of 77.11%, 60.24%, 75.90%, and 81.93%, respectively. The AUC ofcombined detection of the four indexes for predicting prognosis was 0.945, with a sensitivity of 90.00% and a specificityof 86.75%. The risk of poor prognosis in patients with low K and Vs values was 6.512 times and 4.741 times as high asthat in patients with high values, respectively, while the risk of poor prognosis in patients with high HT and MTT valueswas 4.648 times and 7.590 times as high as that in patients with low values, respectively (P<0.05). Conclusion Quanti-tative parameters K, Vs, HT, MTT are related to right ventricular systolic function and prognosis in patients with pulmo-nary heart disease, and detection of the four parameters can be used as one of the effective methods for clinical evalua-tion of prognosis.
      【Key words】 Pulmonary heart disease; Right ventricular contrast echocardiography; Quantitative analysis; Rightventricular systolic function; Prognosis; Predictive efficacy