实时三维超声心动图评价右心室整体和节段容积及收缩功能的临床与实验研究
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摘要
第一部分实时三维超声心动图评价正常人右心室整体和节段容积及收缩功能的临床研究
目的运用实时三维超声心动图(RT3DE)方法,分析正常人整体和节段容积及收缩功能特点,及其与性别、年龄及常规超声心动图参数之间的相关性,探讨RT3DE在评价正常人右心室整体和节段容积及收缩功能中的应用价值。
方法应用PHILIPS-iE33超声显像仪及匹配的X3-1探头,对53名正常成年人进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的EDV、ESV、SV、EF,计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。
结果51例(96%)正常人RT3DE图像成功运用TomTec软件进行分析。正常人男性组右心室体部、流出道及整体EDV及SV大于女性组(P均<0.05)。男性组右心室三个节段及整体ESV均大于女性组(P均<0.05)。男性组流入道EF略低于女性组(P<0.05),两组右心室整体和体部、流出道节段EF无显著差异。两组右心室整体和三个节段Tmsv、 Tmsv%及收缩同步性参数均无显著差异。组内比较结果显示,男性组和女性组流入道EDV和SV均大于流出道和体部(P均<0.05),两组流入道节段容积占整体容积百分比均大于其余两个节段,节段EF值大小关系均为流入道>流出道>体部(P均<0.05)。相关性分析结果显示,正常人右心室整体EDV与右心室舒张末期内径及面积正相关(P均<0.05),右心室整体ESV与右心室收缩末期内径及面积正相关(P均<0.05),右心室整体SV与常规超声方法测定的右心室每搏输出量正相关(P<0.05),右心室RT3DE参数与年龄无显著相关性。右心室RT3DE参数观察者内和观察者间变异度较低,一致性较高。
结论正常人右心室三个节段容积和收缩功能具有不同的特点,男性和女性右心室整体和节段容积及收缩功能存在一定的差异, RT3DE分析右心室整体和节段容积和收缩功能具有较高的准确性和可重复性。
第二部分实时三维超声心动图评价病理状态右心室整体和节段容积及收缩功能的临床研究
第一节实时三维超声心动图评价房间隔缺损患者右心室整体和节段容积及收缩功能的临床研究
目的运用实时三维超声心动图(RT3DE)方法,分析房间隔缺损(房缺)患者整体和节段容积及收缩功能特点,及其与超声心动图估测的肺动脉收缩压(PASP)和肺血管阻力(PVRe)及房缺内径(ASD-D)之间的相关性。
方法应用PHILIPS-iE33超声显像仪及匹配的X3-1探头,对22名房缺患者及性别年龄匹配的正常对照者行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的EDV、 ESV、 SV、 EF,以各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)为右心室收缩同步性参数。
结果22例房缺患者RT3DE图像均成功运用TomTec软件进行分析。与正常对照组相比,房缺组右心室整体及三个节段的EDV、 ESV和SV均增大(P均<0.001),体部节段EDV和ESV占整体容积的百分比增加,流出道和流入道节段EDV和ESV占整体容积的百分比减小,右心室整体及三个节段的EF均降低(P均<0.05)。两组间右心室整体和各节段Tmsv、 Tmsv%及右心室收缩同步性参数无显著差异。组内比较结果显示,房缺组右心室流出道EDV低于流入道(P<0.05),流出道ESV低于其他两个节段(P<0.05),流入道SV和EF高于其他两个节段(P<0.05),余节段容积参数无显示差异；右心室整体EF高于体部,与流入道及流出道EF无显著差异。相关性分析结果显示,右心室整体和流入道节段EDV、 ESV及SV与ASD-D及PASP正相关(r=0.541～0.704,P均<0.05),右心室整体EF与PVRe负相关(r=-0.477,P<0.05)。
结论房缺患者右心室整体及三个节段的容积增加、收缩功能减弱,其右心室节段容积和收缩功能发生不同程度的改变。房缺患者右心室整体和流入道节段容积与右心室前负荷正相关,右心室整体收缩功能与后负荷程度负性相关。
第二节实时三维超声心动图评价左心瓣膜病患者右心室整体和节段容积及收缩功能的临床研究
目的运用实时三维超声心动图(RT3DE)方法,分析左心瓣膜病(二尖瓣及主动脉瓣病变)患者整体和节段容积及收缩功能特点,及其与超声心动图估测的肺动脉收缩压(PASP)和肺血管阻力(PVRe)之间的相关性。
方法应用PHILIPS-iE33超声显像仪及X3-1探头,对23名左心瓣膜病患者及性别年龄相匹配的正常对照者进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的EDV、 ESV、 SV、 EF,计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。
结果23例左心瓣膜病患者RT3DE图像均成功运用TomTec软件进行分析。与正常对照组相比,瓣膜病组右心室整体及三个节段的EDV和ESV增加(P均<0.05),EF降低(P均<0.05),Tmsv%延长(P均<0.05),Tmsv%-SD、 Tmsv-SD、 Tmsv%-dif及Tmsv-dif增加(P均<0.05)。组内比较结果显示,瓣膜病组右心室流入道EDV和SV大于流出道和体部(P均<0.05),后两者EDV和SV无显著差异；流入道ESV大于流出道(P<0.05)、与体部无显著差异；体部EF低于流出道、流入道及整体EF(P均<0.05),后三者之间无显著差异；三个节段Tmsv及Tmsv%之间均无显著差异。相关性分析结果显示,右心室RT3DE参数与PASP均无显著相关性,右心室整体及流入道节段EF与PVRe之间存在较强的负相关关系(r=-0.686、-0.675,P均<0.001)。
结论左心瓣膜病患者右心室整体及三个节段的容积增加、收缩功能减弱,其右心室节段收缩功能发生不同程度的改变,右心室节段收缩活动存在不同步现象。左心瓣膜病患者右心室整体和流入道节段收缩功能与后负荷负相关。
第三节实时三维超声心动图评价肺动脉高压患者右心室整体和节段容积及收缩功能的临床研究
目的运用实时三维超声心动图(RT3DE)方法,分析肺动脉高压(PAH)患者整体和节段容积及收缩功能特点,及其与右心导管测定的肺动脉收缩压(PASP)和肺血管阻力(PVR)之间的相关性。
方法应用PHILIPS-iE33超声显像仪及X3-1探头,对25名PAH患者及性别年龄匹配的正常对照者进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得左室整体及流入道、体部和流出道三个节段的EDV、ESV、 SV、 EF。计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。记录右心导管测定的PASP及PVR等血流动力学参数。
结果24例(96%)PAH患者RT3DE图像成功运用TomTec软件进行分析。与正常对照组相比,PAH组右心室整体及三个节段的EDV和ESV增加(P均<0.001)、EF降低(P均<0.001),右心室体部和流出道EDV和ESV占右心室整体EDV和ESV的百分比分别增加及降低(P均<0.001),Tmsv%-SD、 Tmsv-SD、 Tmsv%-dif及Tmsv-dif增加(P均<0.05)。组内比较结果显示,PAH组流入道EDV大于流出道(P<0.05),流入道和体部ESV均大于流出道(P均<0.05),流入道SV大于体部和流出道(P均<0.001),右心室流出道、流入道及整体EF高于体部,体部EF最低(P均<0.001),三个节段Tmsv及Tmsv%之间均无显著差异。PAH患者中17例成功进行右心导管检查,相关性分析结果显示,右心室整体及流入道节段EF与超声估测的肺血管阻力(PVRe)负相关(r=-0.644、-0.510,P均<0.05),与右心导管测定的PVR负相关(r=-0.732、-0.592,P均<0.001),右心室整体及流入道节段EF与右心导管测定的PASP负相关(r=-0.486、-0.471,P<0.05),右心室RT3DE参数与超声估测的PASP均无显著相关性。结论PAH患者右心室整体及三个节段的容积增加、收缩功能减弱,其右心室节段容积和收缩功能发生不同程度的改变,右心室节段收缩活动存在不同步,PAH患者右心室整体和流入道节段收缩功能与后负荷负相关。
第三部分实时三维超声心动图评价正常比格犬右心室整体和节段容积及收缩功能的实验研究
目的运用实时三维超声心动图(RT3DE)方法,分析正常比格犬右心室整体和节段容积及收缩功能的特点及其与常规超声心动图参数之间的相关性,探讨RT3DE在评价正常比格犬右心室整体和节段容积及收缩功能中的应用价值。
方法应用PHILIPS-iE33超声显像仪及匹配的X3-1探头,对10条正常比格犬进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的EDV、 ESV、 SV、 EF,计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。
结果8条(80%)正常比格获得满意的RT3DE图像并成功运用TomTec软件进行分析。正常比格犬流入道EDV、 ESV和SV大于流出道和体部(P均<0.05),后两个节段EDV、 ESV和SV无显著差异；右心室整体及三个节段EF、 Tmsv及Tmsv%之间均无显著差异。相关性分析结果显示,正常比格犬右心室整体EDV与普通超声心动图参RVLDd、 RVMDd及RVAd正相关(P均<0.05),右心室整体ESV与普通超声心动图参RVLDs、 RVMDs及RVAs正相关(P均<0.05),右心室整体SV与二维超声估测的左心室SV之间无显著差异；右心室整体及流入道节段的EF与右心室面积变化分数正相关(P<0.05)。右心室RT3DE相关参数观察者内和测试间变异度较低,一致性较好。
结论正常比格犬右心室节段容积具有不同的特点,节段收缩活动具有较高的同步性, RT3DE技术分析正常比格犬右心室整体和节段容积及收缩功能具有较高的准确性和可重复性。
Part I. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in Normal Adults Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate the value of real-time three-dimensional echocardiography (RT3DE) in assessment of right ventricular (RV) global and regional volume and systolic function, and to explore the characteristics of RT3DE parameters in normal adults.
Methods:RT3DE images were acquired from53normal adults for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including RV diameters and areas were calculated and recorded.
Results:RT3DE images were successfully acquired and analyzed in51(96%) normal adults. Higher RV global and regional (body and outflow) EDV and SV, higher global and regional ESV and lower inflow EF were found in the male group when compared with the female group (all P<0.05).There was no significant difference in dyssynchrony parameters between the male and female subjects. It was found that EDV and SV in the inflow compartment were the highest in the three compartments of the right ventricle (all P<0.05), and the difference of regional EF were ordered from larger to smaller as inflow>outflow>body (all P<0.05). The differences among global and regional Tmsv and Tmsv%were not significant. RV global EDV was positively correlated with RV end-diastolic diameters and area (all P<0.05). RV global ESV was positively correlated with RV end-systolic diameters and area (all P<0.05). RV global SV was positively correlated with RV stroke volume. Intra-and inter-variability of RT3DE parameters was relatively low。
Conclusions:In normal adults, there were distinct characters of regional volume and systolic function in the three compartments of the right ventricle, with certain differences between males and females. Evaluation of RV global and regional volume and systolic function using RT3DE method was found to be of relatively high accuracy and reproducibility.
Part Ⅱ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in Pathological Conditions Using Real-time Three-Dimensional Echocardiography
Section Ⅰ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with atrial septal defect Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with secondum atrial septal defect (ASD) using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.
Methods:RT3DE images were acquired from22patients with secundum ASD and22age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVRe) and maximum diameter of ASD (ASD-D) were calculated and recorded.
Results:RT3DE images were successfully acquired analyzed in all the subjects. RV global and regional EDV、 ESV and SV were larger (all P<0.001) and EF was lower (all P<0.05) in the ASD group than in the controls. There were no significant differences in Tmsv、 Tmsv%and RV dyssynchrony parameters between the two groups. In the patients group, EDV in the outflow compartment was lower than that in the inflow compartment (P<0.05); ESV in the outflow compartment was the lowest among the three compartments (P<0.05); SV and EF in the inflow compartment were the highest among the three compartments (P<0.05); RV global EF, similar with regional EF in the inflow and outflow compartments, was higher than that in the body compartment (P<0.05). In patients with ASD, RV global and regional EDV, ESV and SV in the inflow compartment were positively correlated with ASD-D and PASP (r=0.541-0.704, all P<0.05); RV global and regional SV in all the three compartments were positively correlated with ASD-D (r=0.463-0.681, all P<0.05); RV global EF was negatively correlated with PVRe (r=-0.477. P<0.05).
Conclusions:In patients with ASD, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global and regional volumes were positively correlated with RV pre-load and RV global EF was negatively correlated with RV after-load.
Section Ⅱ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with valvular heart disease Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with valvular heart disease using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.
Methods:RT3DE images were acquired from23patients with valvular heart disease and23age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVRe) were calculated and recorded.
Results:RT3DE images were successfully acquired analyzed in all the subjects. RV global and regional EDV, ESV and SV were larger (all P<0.05) and EF was lower (all P<0.05) in patients with valvular heart disease than in the controls. RV dyssynchrony parameters including Tmsv%-SD, Tmsv-SD, Tmsv%-dif and Tmsv-dif were higher in patients with valvular heart disease than in the controls (all P<0.05). In patients group, EDV and SV in the inflow compartment was the highest among three compartments (P<0.05); ESV in the inflow compartment was higher than that in the outflow compartment (P<0.05); RV global EF, similar with regional EF in the inflow and outflow compartments, was higher than that in the body compartment (P<0.05). In patients with valvular heart diseases, there was no significant correlation between RT3DE parameters and PASP; RV global EF and EF in the inflow compartment were negatively correlated with PVRe (r=-0.686,-0.675, both P<0.001).
Conclusions:In patients with valvular heart disease, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global EF and regional EF in the inflow compartment were negatively correlated with RV after-load.
Section III. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with pulmonary arterial hypertension Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with pulmonary arterial hypertension (PAH) using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by right heart catheterization (RHC).
Methods:RT3DE images were acquired from25patients with PAH and25age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. RHC was performed in17patients to obtain pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR).
Results:RT3DE images were successfully acquired analyzed in24(96%) patients with PAH. RV global and regional EDV, ESV and SV were larger (all P<0.001) and EF was lower (all P<0.001) in patients with PAH than in the controls. RV dyssynchrony parameters including Tmsv%-SD, Tmsv-SD, Tmsv%-dif and Tmsv-dif were higher in patients with PAH than in the controls (all P<0.05). In the patients group, EDV in the inflow compartment was higher than in the outflow compartment (P<0.05); ESV in the inflow and body compartments were higher than in the outflow compartment (P<0.05); SV in the inflow compartment was the highest among the three compartments (P<0.05); EF in the body compartment was the lowest among the three compartments (P<0.05). In patients with PAH, RV global EF and regional EF in the inflow compartment were negatively correlated with PASP (r=-0.486、-0.471, both P<0.05) and PVR measured by RHC (r=-0.732,-0.592, both P<0.001), and with PVR estimated by echocardiography (r=-0.644,-0.510. both P<0.05).
Conclusions:In patients with PAH, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global and regional EF in the inflow compartment were negatively correlated with RV after-load.
Part Ⅲ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in healthy Beagle Dogs Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate the value of real-time three-dimensional echocardiography (RT3DE) in assessment of right ventricular (RV) global and regional volume and systolic function, and to explore the characteristics of RT3DE parameters in healthy canine model.
Methods:RT3DE images were acquired from10healthy Beagle dogs for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including RV diameters and left ventricular stroke volume were calculated and recorded.
Results:RT3DE images were successfully acquired and analyzed in8(80%) Beagles. It was found that EDV, ESV and SV in the inflow compartment were the highest in the three compartments of the right ventricle of healthy Beagle dogs (all P<0.05), and there was no significant differences between EDV ESV and SV in the body and outflow compartment. The differences among global and regional EF, Tmsv and Tmsv%were not significant. RV global EDV was positively correlated with RV end-diastolic diameters and area (all P<0.05). RV global ESV was positively correlated with RV end-systolic diameters and area (all P<0.05). There was no significant difference between RV global SV and left ventricular stroke volume. RV global EF and EF in the inflow compartment were positively correlated with RV fractional area change (r=0.656,0.757, both P<0.05). Intra-observer and test-retest variability of RT3DE parameters was relatively low。
Conclusions:In healthy Beagle dogs, there were distinct characters of regional volume and systolic function in the three compartments of the right ventricle; evaluation of RV global and regional volume and systolic function using RT3DE method was found to be of relatively high accuracy and reproducibility, and the present research provide a basis for further study of the changes in the right ventricle in canine models.
目的运用实时三维超声心动图(RT3DE)方法,分析正常人整体和节段容积及收缩功能特点,及其与性别、年龄及常规超声心动图参数之间的相关性,探讨RT3DE在评价正常人右心室整体和节段容积及收缩功能中的应用价值。
方法应用PHILIPS-iE33超声显像仪及匹配的X3-1探头,对53名正常成年人进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的EDV、ESV、SV、EF,计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。
结果51例(96%)正常人RT3DE图像成功运用TomTec软件进行分析。正常人男性组右心室体部、流出道及整体EDV及SV大于女性组(P均<0.05)。男性组右心室三个节段及整体ESV均大于女性组(P均<0.05)。男性组流入道EF略低于女性组(P<0.05),两组右心室整体和体部、流出道节段EF无显著差异。两组右心室整体和三个节段Tmsv、 Tmsv%及收缩同步性参数均无显著差异。组内比较结果显示,男性组和女性组流入道EDV和SV均大于流出道和体部(P均<0.05),两组流入道节段容积占整体容积百分比均大于其余两个节段,节段EF值大小关系均为流入道>流出道>体部(P均<0.05)。相关性分析结果显示,正常人右心室整体EDV与右心室舒张末期内径及面积正相关(P均<0.05),右心室整体ESV与右心室收缩末期内径及面积正相关(P均<0.05),右心室整体SV与常规超声方法测定的右心室每搏输出量正相关(P<0.05),右心室RT3DE参数与年龄无显著相关性。右心室RT3DE参数观察者内和观察者间变异度较低,一致性较高。
结论正常人右心室三个节段容积和收缩功能具有不同的特点,男性和女性右心室整体和节段容积及收缩功能存在一定的差异, RT3DE分析右心室整体和节段容积和收缩功能具有较高的准确性和可重复性。
第二部分实时三维超声心动图评价病理状态右心室整体和节段容积及收缩功能的临床研究
第一节实时三维超声心动图评价房间隔缺损患者右心室整体和节段容积及收缩功能的临床研究
目的运用实时三维超声心动图(RT3DE)方法,分析房间隔缺损(房缺)患者整体和节段容积及收缩功能特点,及其与超声心动图估测的肺动脉收缩压(PASP)和肺血管阻力(PVRe)及房缺内径(ASD-D)之间的相关性。
方法应用PHILIPS-iE33超声显像仪及匹配的X3-1探头,对22名房缺患者及性别年龄匹配的正常对照者行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的EDV、 ESV、 SV、 EF,以各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)为右心室收缩同步性参数。
结果22例房缺患者RT3DE图像均成功运用TomTec软件进行分析。与正常对照组相比,房缺组右心室整体及三个节段的EDV、 ESV和SV均增大(P均<0.001),体部节段EDV和ESV占整体容积的百分比增加,流出道和流入道节段EDV和ESV占整体容积的百分比减小,右心室整体及三个节段的EF均降低(P均<0.05)。两组间右心室整体和各节段Tmsv、 Tmsv%及右心室收缩同步性参数无显著差异。组内比较结果显示,房缺组右心室流出道EDV低于流入道(P<0.05),流出道ESV低于其他两个节段(P<0.05),流入道SV和EF高于其他两个节段(P<0.05),余节段容积参数无显示差异；右心室整体EF高于体部,与流入道及流出道EF无显著差异。相关性分析结果显示,右心室整体和流入道节段EDV、 ESV及SV与ASD-D及PASP正相关(r=0.541～0.704,P均<0.05),右心室整体EF与PVRe负相关(r=-0.477,P<0.05)。
结论房缺患者右心室整体及三个节段的容积增加、收缩功能减弱,其右心室节段容积和收缩功能发生不同程度的改变。房缺患者右心室整体和流入道节段容积与右心室前负荷正相关,右心室整体收缩功能与后负荷程度负性相关。
第二节实时三维超声心动图评价左心瓣膜病患者右心室整体和节段容积及收缩功能的临床研究
目的运用实时三维超声心动图(RT3DE)方法,分析左心瓣膜病(二尖瓣及主动脉瓣病变)患者整体和节段容积及收缩功能特点,及其与超声心动图估测的肺动脉收缩压(PASP)和肺血管阻力(PVRe)之间的相关性。
方法应用PHILIPS-iE33超声显像仪及X3-1探头,对23名左心瓣膜病患者及性别年龄相匹配的正常对照者进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的EDV、 ESV、 SV、 EF,计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。
结果23例左心瓣膜病患者RT3DE图像均成功运用TomTec软件进行分析。与正常对照组相比,瓣膜病组右心室整体及三个节段的EDV和ESV增加(P均<0.05),EF降低(P均<0.05),Tmsv%延长(P均<0.05),Tmsv%-SD、 Tmsv-SD、 Tmsv%-dif及Tmsv-dif增加(P均<0.05)。组内比较结果显示,瓣膜病组右心室流入道EDV和SV大于流出道和体部(P均<0.05),后两者EDV和SV无显著差异；流入道ESV大于流出道(P<0.05)、与体部无显著差异；体部EF低于流出道、流入道及整体EF(P均<0.05),后三者之间无显著差异；三个节段Tmsv及Tmsv%之间均无显著差异。相关性分析结果显示,右心室RT3DE参数与PASP均无显著相关性,右心室整体及流入道节段EF与PVRe之间存在较强的负相关关系(r=-0.686、-0.675,P均<0.001)。
结论左心瓣膜病患者右心室整体及三个节段的容积增加、收缩功能减弱,其右心室节段收缩功能发生不同程度的改变,右心室节段收缩活动存在不同步现象。左心瓣膜病患者右心室整体和流入道节段收缩功能与后负荷负相关。
第三节实时三维超声心动图评价肺动脉高压患者右心室整体和节段容积及收缩功能的临床研究
目的运用实时三维超声心动图(RT3DE)方法,分析肺动脉高压(PAH)患者整体和节段容积及收缩功能特点,及其与右心导管测定的肺动脉收缩压(PASP)和肺血管阻力(PVR)之间的相关性。
方法应用PHILIPS-iE33超声显像仪及X3-1探头,对25名PAH患者及性别年龄匹配的正常对照者进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得左室整体及流入道、体部和流出道三个节段的EDV、ESV、 SV、 EF。计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。记录右心导管测定的PASP及PVR等血流动力学参数。
结果24例(96%)PAH患者RT3DE图像成功运用TomTec软件进行分析。与正常对照组相比,PAH组右心室整体及三个节段的EDV和ESV增加(P均<0.001)、EF降低(P均<0.001),右心室体部和流出道EDV和ESV占右心室整体EDV和ESV的百分比分别增加及降低(P均<0.001),Tmsv%-SD、 Tmsv-SD、 Tmsv%-dif及Tmsv-dif增加(P均<0.05)。组内比较结果显示,PAH组流入道EDV大于流出道(P<0.05),流入道和体部ESV均大于流出道(P均<0.05),流入道SV大于体部和流出道(P均<0.001),右心室流出道、流入道及整体EF高于体部,体部EF最低(P均<0.001),三个节段Tmsv及Tmsv%之间均无显著差异。PAH患者中17例成功进行右心导管检查,相关性分析结果显示,右心室整体及流入道节段EF与超声估测的肺血管阻力(PVRe)负相关(r=-0.644、-0.510,P均<0.05),与右心导管测定的PVR负相关(r=-0.732、-0.592,P均<0.001),右心室整体及流入道节段EF与右心导管测定的PASP负相关(r=-0.486、-0.471,P<0.05),右心室RT3DE参数与超声估测的PASP均无显著相关性。结论PAH患者右心室整体及三个节段的容积增加、收缩功能减弱,其右心室节段容积和收缩功能发生不同程度的改变,右心室节段收缩活动存在不同步,PAH患者右心室整体和流入道节段收缩功能与后负荷负相关。
第三部分实时三维超声心动图评价正常比格犬右心室整体和节段容积及收缩功能的实验研究
目的运用实时三维超声心动图(RT3DE)方法,分析正常比格犬右心室整体和节段容积及收缩功能的特点及其与常规超声心动图参数之间的相关性,探讨RT3DE在评价正常比格犬右心室整体和节段容积及收缩功能中的应用价值。
方法应用PHILIPS-iE33超声显像仪及匹配的X3-1探头,对10条正常比格犬进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的EDV、 ESV、 SV、 EF,计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。
结果8条(80%)正常比格获得满意的RT3DE图像并成功运用TomTec软件进行分析。正常比格犬流入道EDV、 ESV和SV大于流出道和体部(P均<0.05),后两个节段EDV、 ESV和SV无显著差异；右心室整体及三个节段EF、 Tmsv及Tmsv%之间均无显著差异。相关性分析结果显示,正常比格犬右心室整体EDV与普通超声心动图参RVLDd、 RVMDd及RVAd正相关(P均<0.05),右心室整体ESV与普通超声心动图参RVLDs、 RVMDs及RVAs正相关(P均<0.05),右心室整体SV与二维超声估测的左心室SV之间无显著差异；右心室整体及流入道节段的EF与右心室面积变化分数正相关(P<0.05)。右心室RT3DE相关参数观察者内和测试间变异度较低,一致性较好。
结论正常比格犬右心室节段容积具有不同的特点,节段收缩活动具有较高的同步性, RT3DE技术分析正常比格犬右心室整体和节段容积及收缩功能具有较高的准确性和可重复性。
Part I. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in Normal Adults Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate the value of real-time three-dimensional echocardiography (RT3DE) in assessment of right ventricular (RV) global and regional volume and systolic function, and to explore the characteristics of RT3DE parameters in normal adults.
Methods:RT3DE images were acquired from53normal adults for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including RV diameters and areas were calculated and recorded.
Results:RT3DE images were successfully acquired and analyzed in51(96%) normal adults. Higher RV global and regional (body and outflow) EDV and SV, higher global and regional ESV and lower inflow EF were found in the male group when compared with the female group (all P<0.05).There was no significant difference in dyssynchrony parameters between the male and female subjects. It was found that EDV and SV in the inflow compartment were the highest in the three compartments of the right ventricle (all P<0.05), and the difference of regional EF were ordered from larger to smaller as inflow>outflow>body (all P<0.05). The differences among global and regional Tmsv and Tmsv%were not significant. RV global EDV was positively correlated with RV end-diastolic diameters and area (all P<0.05). RV global ESV was positively correlated with RV end-systolic diameters and area (all P<0.05). RV global SV was positively correlated with RV stroke volume. Intra-and inter-variability of RT3DE parameters was relatively low。
Conclusions:In normal adults, there were distinct characters of regional volume and systolic function in the three compartments of the right ventricle, with certain differences between males and females. Evaluation of RV global and regional volume and systolic function using RT3DE method was found to be of relatively high accuracy and reproducibility.
Part Ⅱ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in Pathological Conditions Using Real-time Three-Dimensional Echocardiography
Section Ⅰ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with atrial septal defect Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with secondum atrial septal defect (ASD) using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.
Methods:RT3DE images were acquired from22patients with secundum ASD and22age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVRe) and maximum diameter of ASD (ASD-D) were calculated and recorded.
Results:RT3DE images were successfully acquired analyzed in all the subjects. RV global and regional EDV、 ESV and SV were larger (all P<0.001) and EF was lower (all P<0.05) in the ASD group than in the controls. There were no significant differences in Tmsv、 Tmsv%and RV dyssynchrony parameters between the two groups. In the patients group, EDV in the outflow compartment was lower than that in the inflow compartment (P<0.05); ESV in the outflow compartment was the lowest among the three compartments (P<0.05); SV and EF in the inflow compartment were the highest among the three compartments (P<0.05); RV global EF, similar with regional EF in the inflow and outflow compartments, was higher than that in the body compartment (P<0.05). In patients with ASD, RV global and regional EDV, ESV and SV in the inflow compartment were positively correlated with ASD-D and PASP (r=0.541-0.704, all P<0.05); RV global and regional SV in all the three compartments were positively correlated with ASD-D (r=0.463-0.681, all P<0.05); RV global EF was negatively correlated with PVRe (r=-0.477. P<0.05).
Conclusions:In patients with ASD, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global and regional volumes were positively correlated with RV pre-load and RV global EF was negatively correlated with RV after-load.
Section Ⅱ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with valvular heart disease Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with valvular heart disease using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.
Methods:RT3DE images were acquired from23patients with valvular heart disease and23age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVRe) were calculated and recorded.
Results:RT3DE images were successfully acquired analyzed in all the subjects. RV global and regional EDV, ESV and SV were larger (all P<0.05) and EF was lower (all P<0.05) in patients with valvular heart disease than in the controls. RV dyssynchrony parameters including Tmsv%-SD, Tmsv-SD, Tmsv%-dif and Tmsv-dif were higher in patients with valvular heart disease than in the controls (all P<0.05). In patients group, EDV and SV in the inflow compartment was the highest among three compartments (P<0.05); ESV in the inflow compartment was higher than that in the outflow compartment (P<0.05); RV global EF, similar with regional EF in the inflow and outflow compartments, was higher than that in the body compartment (P<0.05). In patients with valvular heart diseases, there was no significant correlation between RT3DE parameters and PASP; RV global EF and EF in the inflow compartment were negatively correlated with PVRe (r=-0.686,-0.675, both P<0.001).
Conclusions:In patients with valvular heart disease, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global EF and regional EF in the inflow compartment were negatively correlated with RV after-load.
Section III. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with pulmonary arterial hypertension Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with pulmonary arterial hypertension (PAH) using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by right heart catheterization (RHC).
Methods:RT3DE images were acquired from25patients with PAH and25age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. RHC was performed in17patients to obtain pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR).
Results:RT3DE images were successfully acquired analyzed in24(96%) patients with PAH. RV global and regional EDV, ESV and SV were larger (all P<0.001) and EF was lower (all P<0.001) in patients with PAH than in the controls. RV dyssynchrony parameters including Tmsv%-SD, Tmsv-SD, Tmsv%-dif and Tmsv-dif were higher in patients with PAH than in the controls (all P<0.05). In the patients group, EDV in the inflow compartment was higher than in the outflow compartment (P<0.05); ESV in the inflow and body compartments were higher than in the outflow compartment (P<0.05); SV in the inflow compartment was the highest among the three compartments (P<0.05); EF in the body compartment was the lowest among the three compartments (P<0.05). In patients with PAH, RV global EF and regional EF in the inflow compartment were negatively correlated with PASP (r=-0.486、-0.471, both P<0.05) and PVR measured by RHC (r=-0.732,-0.592, both P<0.001), and with PVR estimated by echocardiography (r=-0.644,-0.510. both P<0.05).
Conclusions:In patients with PAH, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global and regional EF in the inflow compartment were negatively correlated with RV after-load.
Part Ⅲ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in healthy Beagle Dogs Using Real-time Three-Dimensional Echocardiography
Objective:To evaluate the value of real-time three-dimensional echocardiography (RT3DE) in assessment of right ventricular (RV) global and regional volume and systolic function, and to explore the characteristics of RT3DE parameters in healthy canine model.
Methods:RT3DE images were acquired from10healthy Beagle dogs for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including RV diameters and left ventricular stroke volume were calculated and recorded.
Results:RT3DE images were successfully acquired and analyzed in8(80%) Beagles. It was found that EDV, ESV and SV in the inflow compartment were the highest in the three compartments of the right ventricle of healthy Beagle dogs (all P<0.05), and there was no significant differences between EDV ESV and SV in the body and outflow compartment. The differences among global and regional EF, Tmsv and Tmsv%were not significant. RV global EDV was positively correlated with RV end-diastolic diameters and area (all P<0.05). RV global ESV was positively correlated with RV end-systolic diameters and area (all P<0.05). There was no significant difference between RV global SV and left ventricular stroke volume. RV global EF and EF in the inflow compartment were positively correlated with RV fractional area change (r=0.656,0.757, both P<0.05). Intra-observer and test-retest variability of RT3DE parameters was relatively low。
Conclusions:In healthy Beagle dogs, there were distinct characters of regional volume and systolic function in the three compartments of the right ventricle; evaluation of RV global and regional volume and systolic function using RT3DE method was found to be of relatively high accuracy and reproducibility, and the present research provide a basis for further study of the changes in the right ventricle in canine models.
引文
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