medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-1461medvis-1461Research ArticleСЕРДЦЕ И СОСУДЫHEART AND VESSELSКомплексная оценка функции правого желудочка при острой тромбоэмболии легочной артерииComprehensive evaluation of right ventricular function in patients with acute pulmonary embolismhttps://orcid.org/0009-0000-4672-2779КондрашоваК. В.KondrashovaK. V.

Кондрашова Ксения Владимировна – врач ультразвуковой диагностики, заведующая отделением ультразвуковой диагностики регионального сосудистого центра ГБУЗ КО “Калужская областная клиническая больница”, Калугаhttps://orcid.org/0009-0000-4672-2779

Ksenia V. Kondrashova – MD, Head of Ultrasound Diagnostics Department, Regional Vascular Center, Kaluga Regional Clinical Hospital, Kalugahttps://orcid.org/0009-0000-4672-2779

xenijasv@yandex.ruРыбаковаМ. К.RybakovaM. K.

Рыбакова Марина Константиновна – доктор мед. наук, профессор кафедры ультразвуковой диагностики ФГБОУ ДПО “Российская медицинская академия непрерывного профессионального образования” Минздрава России, Москва

Marina K. Rybakova – MD, Doct. of Sci. (Med.), Professor, Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscow

rybakova-echo@yandex.ruhttps://orcid.org/0000-0003-1959-9618МитьковаМ. Д.MitkovV. V.

Митькова Мина Даутовна – канд. мед. наук, доцент, доцент кафедры ультразвуковой диагностики ФГБОУ ДПО “Российская медицинская академия непрерывного профессионального образования” Минздрава России, Москваhttps://orcid.org/0000-0002-3870-6522

Vladimir V. Mitkov – MD, Doct. of Sci. (Med.), Professor, Director, Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscowhttps://orcid.org/0000-0003-1959-9618

https://orcid.org/0000-0002-3870-6522МитьковВ. В.MitkovaM. D.

Митьков Владимир Вячеславович – доктор мед. наук, профессор, заведующий кафедрой ультразвуковой диагностики ФГБОУ ДПО “Российская медицинская академия непрерывного профессионального образования” Минздрава России, Москваhttps://orcid.org/0000-0003-1959-9618

Mina D. Mitkova – M.D., Cand. of Sci. (Med.), Associate Professor, Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscowhttps://orcid.org/0000-0002-3870-6522

ГБУЗ Калужской области “Калужская областная клиническая больница”; 248007 Калуга, ул. Вишневского, д. 1, Российская ФедерацияРоссияKaluga Regional Clinical Hospital; 1, Vishnevsky str., Kaluga 248007, Russian FederationRussian FederationФГБОУ ДПО “Российская медицинская академия непрерывного профессионального образования” Минздрава России; 125993 Москва, ул. Баррикадная, д. 2/1, стр. 1, Российская ФедерацияРоссияRussian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation; 2/1-1, Barrikadnaya str., Moscow 125993, Russian FederationRussian Federation2024090920242838998Copyright © Кондрашова К.В., Рыбакова М.К., Митькова М.Д., Митьков В.В., 20242024Кондрашова К.В., Рыбакова М.К., Митькова М.Д., Митьков В.В.Kondrashova K.V., Rybakova M.K., Mitkov V.V., Mitkova M.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/1461Цель исследования

Цель исследования: оценка значения показателей систолической функции правого желудочка (ПЖ) и правожелудочково-артериального сопряжения (ПЖАС) при трансторакальной эхокардиографии (ЭхоКГ) у пациентов с острой субмассивной/массивной тромбоэмболией легочной артерии (ТЭЛА).

Материал и методы

Материал и методы. Обследовано 34 пациента (16 (47,1%) женщин, 18 (52,9%) мужчин) с острой субмассивной/массивной ТЭЛА. Диагноз поставлен на основании КТ-ангиопульмонографии с болюсным внутривенным контрастированием. Средний возраст пациентов составил 61 ± 13 лет (M ± SD). В качестве контрольной группы обследовано 30 здоровых лиц: 16 (53,3%) женщин, 14 (46,7%) мужчин. Средний возраст здоровых лиц составил 39 ± 10 лет. Трансторакальная ЭхоКГ проводилась на аппарате Vivid E95 (GE HealthCare, США) с постобработкой данных на рабочей станции EchoPak. Изучали стандартные показатели систолической функции ПЖ, а также глобальную продольную систолическую деформацию (ГПСД) ПЖ и продольную систолическую деформацию свободной стенки (ПСД СС) ПЖ с помощью двухмерной спекл-трекинг-ЭхоКГ. Кроме того, определяли различные показатели ПЖАС, такие как отношения TAPSE, ФИП ПЖ, ГПСД и ПСД СС к систолическому давлению в легочной артерии (СДЛА).

Результаты

Результаты. У пациентов с острой субмассивной/массивной ТЭЛА все показатели систолической функции ПЖ достоверно отличались от контрольной группы (p от 0,0011 до <0,0001). При этом показатели продольной деформации демонстрировали лучшую информативность по сравнению со стандартными показателями систолической функции ПЖ (AUC – 0,898–0,912 против 0,738–0,849). Отмечено также достоверное снижение (p < 0,0001) всех параметров ПЖАС (TAPSE/СДЛА, ФИП ПЖ/СДЛА, ГПСД ПЖ/СДЛА, ПСД СС ПЖ/СДЛА) у пациентов с ТЭЛА по сравнению с контрольной группой. Информативность показателей ПЖАС (AUC – 0,991–0,997) была выше всех показателей систолической функции. Наибольшую информативность среди показателей ПЖАС продемонстрировал ГПСД ПЖ/СДЛА <0,66 %/мм рт. ст. (чувствительность – 94,1%, специфичность – 100,0%, AUC – 0,997).

Выводы

Выводы. Включение параметров продольной деформации и ПЖАС в исследование функции ПЖ повышает выявляемость его дисфункции при острой субмассивной/массивной ТЭЛА.

Objective

Objective. To study indices of right ventricular (RV) longitudinal deformation at transthoracic echocardiography (TTE) in patients with acute pulmonary embolism (APE), to determine their threshold values; to study indices of right ventricular-arterial coupling (RVAC) in patients with APE, to determine their threshold values.

Methods

Methods. We examined 34 patients with acute massive and submassive pulmonary embolism. The diagnosis was made on the basis of computed-tomography pulmonary angiogram. The mean age was 61 ±13 years. Of these, 16 were women (47,1%) and 18 were men (52,9%). As a control group, 30 healthy individuals were examined: 14 males and 16 females. The mean age of the healthy individuals was 39±9,8 years. Echocardiography was performed on Vivid E95 (GE HealthCare, USA) with data postprocessing on EchoPak workstation. The indices of right ventricular (RV) systolic and diastolic function, the magnitude of global longitudinal deformation of the right ventricle (GLS RV) and longitudinal deformation of the right ventricular free wall (RVFWLS) were studied using two-dimensional speckle-tracking echocardiography. We studied indices of right ventricular-arterial coupling (RVAC). We determined the relationship of longitudinal deformation of RV and RVAC with other indices of its systolic function. 

Results

Results. Mean values of traditional parameters of RV contractile function were within normal limits, whereas mean values of longitudinal strain in APE were significantly lower than normal. There was also a significant decrease ( P < 0,0001) of all measured parameters of right ventricular-arterial coupling in patients with APE in comparison with the control group.

Conclusions

Conclusions. When longitudinal deformation parameters are included in the criteria of RV dysfunction in APE, its detectability increases from 26,47% to 61,77%. The revealed decrease of right ventricular-arterial coupling parameters in APE indicates a more frequent disturbance of the connection between RV and the small circle of blood circulation

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The authors declare that there are no conflicts of interest present.