Sade Leyla Elif, Kozan Hatice, Eroglu Serpil, Pirat Bahar, Aydinalp Alp, Sezgin Atilla, Muderrisoglu Haldun
Department of Cardiology, Baskent University Medical School, Ankara, Turkey.
Exp Clin Transplant. 2017 Feb;15(Suppl 1):231-235. doi: 10.6002/ect.mesot2016.P104.
Residual pulmonary hypertension challenges the right ventricular function and worsens the prognosis in heart transplant recipients. The complex geometry of the right ventricle complicates estimation of its function with conventional transthoracic echocardiography. We evaluated right ventricular function in heart transplant recipients with the use of 3-dimensional echocardiography in relation to systolic pulmonary artery pressure.
We performed 32 studies in 26 heart transplant patients, with 6 patients having 2 studies at different time points with different pressures and thus included. Right atrial volume, tricuspid annular plane systolic excursion, peak systolic annular velocity, fractional area change, and 2-dimensional speckle tracking longitudinal strain were obtained by 2-dimensional and tissue Doppler imaging. Three-dimensional right ventricular volumes, ejection fraction, and 3-dimensional right ventricular strain were obtained from the 3-dimensional data set by echocardiographers. Systolic pulmonary artery pressure was obtained during right heart catheterization.
Overall mean systolic pulmonary artery pressure was 26 ± 7 mm Hg (range, 14-44 mmHg). Three-dimensional end-diastolic (r = 0.75; P < .001) and end-systolic volumes (r = 0.55; P = .001)correlated well with systolic pulmonary artery pressure. Right ventricular ejection fraction and right atrium volume also significantly correlated with systolic pulmonary artery pressure (r = 0.49 and P = .01 for both). However, right ventricular 2- and 3-dimensional strain, tricuspid annular plane systolic excursion, and tricuspid annular velocity did not.
The effects of pulmonary hemodynamic burden on right ventricular function are better estimated by a 3-dimensional volume evaluation than with 3-dimensional longitudinal strain and other 2-dimensional and tissue Doppler measurements. These results suggest that the peculiar anatomy of the right ventricle necessitates 3-dimensional volume quantification in heart transplant recipients in relation to residual pulmonary hypertension.
残余肺动脉高压对心脏移植受者的右心室功能构成挑战，并使预后恶化。右心室复杂的几何形状使得用传统经胸超声心动图评估其功能变得复杂。我们使用三维超声心动图评估心脏移植受者的右心室功能，并将其与收缩期肺动脉压相关联。
我们对26例心脏移植患者进行了32项研究，其中6例患者在不同时间点、不同压力下进行了2项研究，因此被纳入。通过二维和组织多普勒成像获得右心房容积、三尖瓣环平面收缩期位移、收缩期峰值环速度、面积变化分数和二维斑点追踪纵向应变。超声心动图医生从三维数据集中获取三维右心室容积、射血分数和三维右心室应变。在右心导管检查期间获取收缩期肺动脉压。
总体平均收缩期肺动脉压为26±7 mmHg（范围为14 - 44 mmHg）。三维舒张末期容积（r = 0.75；P <.001）和收缩末期容积（r = 0.55；P =.001）与收缩期肺动脉压密切相关。右心室射血分数和右心房容积也与收缩期肺动脉压显著相关（两者r均为0.49，P = .01）。然而，右心室二维和三维应变、三尖瓣环平面收缩期位移和三尖瓣环速度则不然。
与三维纵向应变以及其他二维和组织多普勒测量相比，通过三维容积评估能更好地估计肺血流动力学负荷对右心室功能的影响。这些结果表明，右心室独特的解剖结构使得在心脏移植受者中针对残余肺动脉高压进行三维容积量化很有必要。
