Nadorlik Holly, Stiver Corey, Khan Sairah, Miao Yongjie, Holzer Ralf, Cheatham John P, Cua Clifford L
Heart Center, Nationwide Children's Hospital,Columbus,Ohio,United States of America.
Cardiol Young. 2017 Aug;27(6):1186-1193. doi: 10.1017/S1047951116002821. Epub 2017 Mar 30.
Newer echocardiographic techniques may allow for more accurate assessment of right ventricular function. Adult studies have correlated these echocardiographic measurements with invasive data, but minimal data exist in the paediatric congenital heart population. The purpose of this study was to evaluate echocardiographic measurements that correlate best with right ventricular systolic and diastolic catheterisation parameters.
Patients with two-ventricle physiology who underwent simultaneous echocardiogram and cardiac catheterisation were included in this study. Right ventricular systolic echocardiographic data included fractional area change, displacement, tissue Doppler imaging s' wave, global longitudinal strain, and strain rate s' wave. Diastolic echocardiographic data included tricuspid E and A waves, tissue Doppler imaging e' and a' waves, and strain rate e' and a' waves. E/tissue Doppler imaging e', tissue Doppler imaging e'/tissue Doppler imaging a', E/strain rate e', and strain rate e'/strain rate a' ratios were also calculated. Catheterisation dP/dt was used as a marker for systolic function and right ventricular end-diastolic pressure for diastolic function.
A total of 32 patients were included in this study. The median age at catheterisation was 3.1 years (0.3-17.6 years). The DP/dt was 493±327 mmHg/second, and the right ventricular end-diastolic pressure was 7.7±2.4 mmHg. There were no significant correlations between catheterisation dP/dt and systolic echocardiographic parameters. Right ventricular end-diastolic pressure correlated significantly with strain rate e' (r=-0.4, p=0.02), strain rate a' (r=-0.5, p=0.03), and E/tissue Doppler imaging e' (r=0.4, p=0.04).
Catheterisation dP/dt did not correlate with echocardiographic measurements of right ventricular systolic function. Strain rate and tissue Doppler imaging analysis significantly correlated with right ventricular end-diastolic pressure. These values should be further studied to determine whether they may be used as an alternative method to estimate right ventricular end-diastolic pressure in this patient population.
更新的超声心动图技术可能有助于更准确地评估右心室功能。成人研究已将这些超声心动图测量值与侵入性数据相关联，但儿科先天性心脏病患者的数据极少。本研究的目的是评估与右心室收缩和舒张导管插入术参数相关性最佳的超声心动图测量值。
本研究纳入了接受同步超声心动图和心导管检查的双心室生理患者。右心室收缩期超声心动图数据包括面积变化分数、位移、组织多普勒成像s波、整体纵向应变和应变率s波。舒张期超声心动图数据包括三尖瓣E波和A波、组织多普勒成像e'波和a'波，以及应变率e'波和a'波。还计算了E/组织多普勒成像e'、组织多普勒成像e'/组织多普勒成像a'、E/应变率e'和应变率e'/应变率a'比值。导管插入术dP/dt用作收缩功能的标志物，右心室舒张末期压力用作舒张功能的标志物。
本研究共纳入32例患者。导管插入术时的中位年龄为3.1岁（0.3 - 17.6岁）。DP/dt为493±327 mmHg/秒，右心室舒张末期压力为7.7±２.4 mmHg。导管插入术dP/dt与收缩期超声心动图参数之间无显著相关性。右心室舒张末期压力与应变率e'（r = -0.4，p = 0.02）、应变率a'（r = -0.5，p = 0.03）和E/组织多普勒成像e'（r = 0.4，p = 0.04）显著相关。
导管插入术dP/dt与右心室收缩功能的超声心动图测量值不相关。应变率和组织多普勒成像分析与右心室舒张末期压力显著相关。应进一步研究这些值，以确定它们是否可作为估计该患者群体右心室舒张末期压力的替代方法。
