Lu Ken J, Chen Janet X C, Profitis Konstantinos, Kearney Leighton G, DeSilva Dimuth, Smith Gerard, Ord Michelle, Harberts Susan, Calafiore Paul, Jones Elizabeth, Srivastava Piyush M
Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Echocardiography. 2015 Jun;32(6):966-74. doi: 10.1111/echo.12783. Epub 2014 Oct 7.
Accurate assessment of right ventricular (RV) systolic function is important, as it is an established predictor of mortality in cardiac and respiratory diseases. We aimed to compare speckle tracking-derived longitudinal deformation measurements with traditional two-dimensional (2D) echocardiographic parameters, as well as real time three-dimensional echocardiography (RT3DE) and cardiac magnetic resonance imaging (CMR)-derived RV volumes and ejection fraction (EF).
Subjects referred for CMR also underwent echocardiography. On both RT3DE and CMR, we measured RV volumes and EF. On 2D echocardiography, we analyzed RV fractional area change, RV internal diastolic diameter, tricuspid annular plane systolic excursion, tricuspid annular tissue Doppler-derived velocity, myocardial performance index, and RV global longitudinal strain (RV GLS).
Sixty subjects were recruited (mean age = 45 ± 10 years; 60% male). RV GLS (R = -0.69, P < 0.001) and RT3DE RVEF (R = 0.56, P < 0.001) correlated well with CMR RVEF. RT3DE RV end-diastolic (RVEDV) and end-systolic (RVESV) volumes also correlated with CMR RV volumes: RVEDV, R = 0.74, P < 0.001 and RVESV, R = 0.84, P < 0.001. In addition, RV GLS best predicted the presence of RV dysfunction, defined as RVEF <48% on CMR (hazard ratio = 7.0 [1.5-31.7], P < 0.01). On receiver operator characteristic analysis, a RV GLS of -20% was the most sensitive and specific predictor of RV dysfunction (AUC 0.8 [0.57-1.0], P < 0.02).
RVEF and volumes estimated on RT3DE were closely correlated with CMR measurements. When compared to more traditional markers of RV systolic function and RT3DE, RVGLS produced the highest correlation with CMR RVEF and was a good predictor of RV dysfunction. RV GLS should be considered a complementary modality to RT3DE and CMR in the assessment of RV systolic function.
准确评估右心室（RV）收缩功能很重要，因为它是心脏和呼吸系统疾病死亡率的既定预测指标。我们旨在比较斑点追踪得出的纵向变形测量值与传统二维（2D）超声心动图参数，以及实时三维超声心动图（RT3DE）和心脏磁共振成像（CMR）得出的RV容积和射血分数（EF）。
接受CMR检查的受试者也接受了超声心动图检查。在RT3DE和CMR上，我们测量了RV容积和EF。在二维超声心动图上，我们分析了RV面积变化分数、RV舒张期内径、三尖瓣环平面收缩期位移、三尖瓣环组织多普勒衍生速度、心肌性能指数和RV整体纵向应变（RV GLS）。
招募了60名受试者（平均年龄 = 45 ± 10岁；60%为男性）。RV GLS（R = -0.69，P < 0.001）和RT3DE RV EF（R = 0.56，P < 0.001）与CMR RV EF相关性良好。RT3DE RV舒张末期（RVEDV）和收缩末期（RVESV）容积也与CMR RV容积相关：RVEDV，R = 0.74，P < 0.001；RVESV，R = 0.84，P < 0.001。此外，RV GLS最能预测RV功能障碍的存在，定义为CMR上RVEF < 48%（风险比 = 7.0 [1.5 - 31.7]，P < 0.01）。在受试者工作特征分析中，RV GLS为 -20%是RV功能障碍最敏感和特异的预测指标（AUC 0.8 [0.57 - 1.0]，P < 0.02）。
RT3DE估计的RVEF和容积与CMR测量值密切相关。与RV收缩功能的更传统标志物和RT3DE相比，RVGLS与CMR RVEF的相关性最高，并且是RV功能障碍的良好预测指标。在评估RV收缩功能时，RV GLS应被视为RT3DE和CMR的补充方式。
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