实时三维超声心动图（RT3D）用于评估高血压和心力衰竭患者的心室及血管功能。

Real time 3D echocardiography (RT3D) for assessment of ventricular and vascular function in hypertensive and heart failure patients.

作者信息

Scali Maria Chiara, Basso Massimiliano, Gandolfo Alfredo, Bombardini Tonino, Bellotti Paolo, Sicari Rosa

机构信息

Cardiologia Asl 2 Lucca, Lucca, Italy.

出版信息

Cardiovasc Ultrasound. 2012 Jun 28;10:27. doi: 10.1186/1476-7120-10-27.

DOI:10.1186/1476-7120-10-27

PMID:22742054

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3439359/

Abstract

BACKGROUND

Cardiac and systemic hemodynamics have been historically in the domain of invasive cardiology, but recent advances in real-time 3-Dimensional echocardiography (RT3D echo) provide a reliable measurement of ventricular volumes, allowing to measure a set of hemodynamic parameters previously difficult or impossible to obtain with standard 2D echo.

AIM

To assess the feasibility of a comprehensive hemodynamic study with RT-3D echo.

METHODS

We enrolled 136 patients referred for routine echocardiography: 44 normal (N), 57 hypertensive (HYP), and 35 systolic heart failure patients (HF). All patients underwent standard 2D echo examination followed by RT3D echo examination, including measurement of left ventricular (LV) end-diastolic and end-systolic volumes and derived assessment of LV elastance (an index of LV contractility), arterial elastance (characterizing the distal impedance of the arterial system downstream of the aortic valve); ventricular-arterial coupling (a central determinant of net cardiovascular performance); systemic vascular resistances. Blood pressure was derived from cuff sphygmomanometer and heart rate from ECG.

RESULTS

A complete 2D echo was performed in all 136 patients. 3D echo examination was obtained in 130 patients (feasibility = 95 %). Standard 2D echo examination was completed in 14.8 ± 2.2 min. Acquisition of 3D images required an average time of 5 ± 0.9 min (range 3.5-7.5 min) and image analysis was completed in 10.1 ± 2.8 min (range 6-12 min) per patient. Compared to N and HYP, HF patients showed reduced LV elastance (1.7 ± 1.5 mmHg mL(-1) m(-2), p < 0.001 vs N = 3.8 ± 1.3 and HYP = 3.8 ± 1.3) and ventricular-arterial coupling (0.6 ± 0.5, p < 0.01 vs N = 1.4 ± 0.4 and HYP = 1.2 ± 0.4). Systemic vascular resistances were highest in HYP (2736 ± 720, p < .01 vs N = 1980 ± 432 and vs HF = 1855 ± 636 dyne*s/cm5). The LV elastance was related to EF (r = 0.73, p < 0.01) and arterial pressure was moderately related to vascular elastance (r = 0.54, p < 0.01). The ventricular-arterial coupling was unrelated to systemic vascular resistances (r = -0.04, p NS).

CONCLUSION

RT-3D echo allows a non invasive, comprehensive assessment of cardiac and systemic hemodynamics, offering insight access to key variables--such as increased systemic vascular resistances in hypertensives and reduced ventricular-arterial coupling in heart failure patients.

摘要

背景

心脏和全身血流动力学一直以来都属于侵入性心脏病学的范畴，但实时三维超声心动图（RT3D 超声心动图）的最新进展提供了可靠的心室容积测量方法，能够测量一组以前用标准二维超声心动图难以或无法获得的血流动力学参数。

目的

评估使用 RT-3D 超声心动图进行全面血流动力学研究的可行性。

方法

我们纳入了 136 例因常规超声心动图检查而转诊的患者：44 例正常（N），57 例高血压（HYP），35 例收缩性心力衰竭患者（HF）。所有患者均接受标准二维超声心动图检查，随后进行 RT3D 超声心动图检查，包括测量左心室（LV）舒张末期和收缩末期容积，并推导评估左心室弹性（左心室收缩性指标）、动脉弹性（表征主动脉瓣下游动脉系统的远端阻抗）；心室-动脉耦合（心血管净功能的核心决定因素）；全身血管阻力。血压通过袖带血压计测量，心率通过心电图测量。

结果

136 例患者均完成了完整的二维超声心动图检查。130 例患者获得了三维超声心动图检查结果（可行性 = 95%）。标准二维超声心动图检查在 14.8 ± 2.2 分钟内完成。获取三维图像每位患者平均需要 5 ± 0.9 分钟（范围 3.5 - 7.5 分钟），图像分析在 10.1 ± 2.8 分钟（范围 6 - 12 分钟）内完成。与 N 和 HYP 组相比，HF 患者的左心室弹性降低（1.7 ± 1.5 mmHg·mL⁻¹·m⁻²，与 N = 3.8 ± 1.3 和 HYP = 3.8 ± 1.3 相比，p < 0.001），心室-动脉耦合降低（0.6 ± 0.5，与 N = 1.4 ± 0.4 和 HYP = 1.2 ± 0.4 相比，p < 0.0１）。全身血管阻力在 HYP 组最高（2736 ± 720，与 N = 1980 ± 432 和 HF = 1855 ± 636 dyne*s/cm⁵ 相比，p < 0.0１）。左心室弹性与射血分数相关（r = 0.73，p < 0.01），动脉压与血管弹性中度相关（r = 0.54，p < 0.01）。心室-动脉耦合与全身血管阻力无关（r = -0.04，p 无统计学意义）。