Tüller David, Steiner Martin, Wahl Andreas, Kabok Marika, Seiler Christian
Department of Cardiology, University Hospital, Berne, Switzerland.
Swiss Med Wkly. 2005 Aug 6;135(31-32):461-8. doi: 10.4414/smw.2005.11043.
Systolic right ventricular (RV) function is an important predictor in the course of various congenital and acquired heart diseases. So far, tricuspid annular motion velocity in systole as obtained by pulsed wave tissue Doppler imaging (TDI) has rarely been investigated for RV function assessment in a sizeable adult patient population.
258 individuals were included in the study. Among them, there were 107 individuals without cardiovascular disease, 71 patients with predominant RV dysfunction, 40 patients with pulmonary artery hypertension, and 40 patients with predominant left ventricular dysfunction. The reference methods for RV systolic function assessment were biplane two-dimensional echocardiography and magnetic resonance imaging (MRI; n = 31) for the calculation of RV ejection fraction (EF). Lateral tricuspid valve annular motion velocities in systole (TVlat, cm/s) were recorded using pulsed wave TDI from the apical 4-chamber view (long axis function).
RV EF as determined by biplane echocardiography correlated significantly with respective values as assessed by MRI: RVEFecho = RV EFMRI + 1.6; r2 = 0.569, p <0.0001. Using the best TVlat threshold of 12 cm/s, distinction between the group with RV dysfunction and the other groups was possible with 86% sensitivity and 83% specificity. There was a direct and significant correlation between TVlat and RV ejection fraction (p <0.0001). Using TVlat thresholds of 12 and 9 cm/s, distinction between normal RV EF (>55%), moderately reduced (30-55%) and severely reduced RV EF (<30%) was possible with 84% sensitivity and 81% specificity, respectively with 83% sensitivity and 67% specificity.
Systolic long axis velocity measurement of the lateral tricuspid annulus is useful and accurate to assess RV systolic function in a broad patient population. Thresholds of 12 and 9 cm/s allow differentiation between normal, moderately reduced and severely reduced RV ejection fraction.
收缩期右心室（RV）功能是各种先天性和后天性心脏病病程中的重要预测指标。到目前为止，在大量成年患者群体中，通过脉冲波组织多普勒成像（TDI）获得的收缩期三尖瓣环运动速度很少用于评估RV功能。
本研究纳入了258名个体。其中，107名个体无心血管疾病，71名主要为RV功能障碍患者，40名肺动脉高压患者，40名主要为左心室功能障碍患者。评估RV收缩功能的参考方法是双平面二维超声心动图和磁共振成像（MRI；n = 31），用于计算RV射血分数（EF）。使用脉冲波TDI从心尖四腔心切面（长轴功能）记录收缩期三尖瓣环外侧运动速度（TVlat，cm/s）。
双平面超声心动图测定的RV EF与MRI评估的相应值显著相关：RVEFecho = RV EFMRI + 1.6；r2 = 0.569，p <0.0001。使用12 cm/s的最佳TVlat阈值，可以区分RV功能障碍组与其他组，敏感性为86%，特异性为83%。TVlat与RV射血分数之间存在直接且显著的相关性（p <0.0001）。使用12 cm/s和9 cm/s的TVlat阈值，可以区分正常RV EF（>55%）、中度降低（30 - 55%）和严重降低的RV EF（<30%），敏感性分别为84%和83%，特异性分别为81%和67%。
测量三尖瓣环外侧收缩期长轴速度对于评估广泛患者群体的RV收缩功能是有用且准确的。12 cm/s和9 cm/s的阈值可用于区分正常、中度降低和严重降低的RV射血分数。
