Badano Luigi P, Ginghina Carmen, Easaw Jacob, Muraru Denisa, Grillo Maria T, Lancellotti Patrizio, Pinamonti Bruno, Coghlan Gerry, Marra Martina Perazzolo, Popescu Bogdan A, De Vita Salvatore
Department of Cardiopulmonary Sciences, University Hospital S Maria della Misericordia, P.le S Maria della Misericordia 15, 33100 Udine, Italy.
Eur J Echocardiogr. 2010 Jan;11(1):27-37. doi: 10.1093/ejechocard/jep152. Epub 2009 Oct 7.
Although right ventricular (RV) failure is the main cause of death in patients with pulmonary arterial hypertension (PAH), there is insufficient data about the effects of PAH treatment on RV geometry and function mainly because the RV assessment has been hampered by its complex crescentic shape, large infundibulum, and its trabecular nature. Echocardiography is a widely available imaging technique particularly suitable for follow-up studies, because of its non-invasive nature, low cost, and lack of ionizing radiation or radioactive agent. Real-time three-dimensional echocardiography (RT3DE) has been shown to be accurate in assessing RV and left ventricular (LV) volumes, stroke volumes, and ejection fractions in comparison with cardiac magnetic resonance imaging. In this review, we describe RV structural and functional changes which occur in patients with PAH and strengths and weaknesses of current non-invasive imaging techniques to assess them. Finally, we describe an ongoing multicentre, prospective observational study involving seven centres expert in treating patients with PAH from four different countries. Investigators will use conventional and advanced echo parameters from RT3DE and speckle-tracking echocardiography to assess the extent of LV and RV remodelling before symptom onset and during pharmacological treatment in patients with PAH. Seventy patients who will survive for at least 1 year will be recruited. All the participating institutions will perform comprehensive standard 2D and Doppler as well as RT3DE examinations with a pre-defined imaging protocol. Measurements will be performed at the core echocardiography laboratory by experienced observers who will be unaware of each patient's treatment assignment and whether the examination was a baseline or a follow-up study. Enrolment duration is expected to be 1 year.
尽管右心室（RV）衰竭是肺动脉高压（PAH）患者的主要死因，但关于PAH治疗对RV几何形状和功能影响的数据不足，主要是因为RV评估受到其复杂的新月形、大漏斗部及其小梁性质的阻碍。超声心动图是一种广泛应用的成像技术，特别适合随访研究，因为它具有非侵入性、成本低且无电离辐射或放射性剂的特点。与心脏磁共振成像相比，实时三维超声心动图（RT3DE）已被证明在评估RV和左心室（LV）容积、每搏量和射血分数方面是准确的。在本综述中，我们描述了PAH患者发生的RV结构和功能变化以及当前评估这些变化的非侵入性成像技术的优缺点。最后，我们描述了一项正在进行的多中心前瞻性观察性研究，该研究涉及来自四个不同国家的七个治疗PAH患者的专家中心。研究人员将使用RT3DE和斑点追踪超声心动图的传统和先进回声参数，评估PAH患者在症状出现前和药物治疗期间LV和RV重塑的程度。将招募至少存活1年的70名患者。所有参与机构将按照预先定义的成像方案进行全面的标准二维和多普勒以及RT3DE检查。测量将由经验丰富的观察者在核心超声心动图实验室进行，他们将不知道每位患者的治疗分配情况以及检查是基线检查还是随访研究。预计入组持续时间为1年。
