三维斑点追踪显像评估压力负荷升高右室心肌力学改变及机制初探

多种心血管疾病可致右室急性或慢性压力负荷升高（aPO或cPO），右室心肌功能改变与其病情进展及预后密切相关。目前临床缺乏早期评估右室心肌功能的有效方法。我们前期研究采用二维斑点追踪显像（STI）技术发现cPO时尽管右室整体功能正常，但其心肌力学已发生改变。但二维STI局限于二维平面，而且右室心肌力学与组织学、细胞分子变化关系尚不清楚。新近研究表明三维STI（3D-STI）可早期显示左室心肌力学改变,但未见应用于右室的报道。因此我们假设3D-STI可评价压力负荷升高所致的右室心肌力学早期改变，通过实验和临床研究，与血清学、血流动力学、核磁共振、心肌病理、细胞分子机制比较来验证该方法的准确性。本研究进一步阐明右室心肌力学改变的组织学及分子生物学基础，进一步明确3D-STI在急性肺栓塞及慢性肺动脉高压患者中的临床意义，旨在为早期发现右室心肌功能受损、有效评估疗效及判断预后提供一种新方法。

A variety of cardiovascular diseases may result in right ventricular(RV) acute or chronic pressure overload(aPO or cPO), RV myocardial function is strongly associated with illness progression and prognosis.We have no effective method for the early assessment of RV myocardial function in the clinical practice. Previous studies have demonstrate that RV myocardial biomechanics may have changed using two-dimensional speckle tracking imaging(STI) although RV global function is normal in the setting of pressure overload. However, two-dimensional STI is limited by two-dimensional plane. Moreover, the correlation between RV myocardial biomechanics and histological, and cellular and molecular mechanism is unknown. Recently, three-dimensional STI (3D-STI)can identify early left ventricular myocardial biomechanics abnormalities, but the application of 3D-STI in RV has not been reported. Therefore, we assume that early RV myocardial biomechanics abnormalities in RV pressure overload can be assessed by 3D-STI. We will confirm the accuracy of 3D-STI by exploring the correlation between the 3D-STI parameters and serology, RV hemodynamic by right heart catheter, cardiac magnetic resonance imaging, myocardial pathomorphology, and cellular and molecular mechanism in the experimental and clinical studies. Furthermore, we will further elaborate the histological and molecular biology basis of RV myocardial biomechanics abnormalities, and clarify the clinical significance of 3D-STI in patients with acute pulmonary embolism and chronic pulmonary artery hypertension.The aim of this study is to provide the novel method for early detecting RV myocardial function impairement, assessing therapeutic effect and judging prognosis in patients with RV aPO and cPO.