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右心室收缩功能的超声心动图评估:传统与创新方法

Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach.

作者信息

Smolarek Dorota, Gruchała Marcin, Sobiczewski Wojciech

机构信息

Department of Cardiology, Hospital of Saint Wojciech, Copernicus, Gdansk, Poland.

出版信息

Cardiol J. 2017;24(5):563-572. doi: 10.5603/CJ.a2017.0051. Epub 2017 May 12.

Abstract

Estimation of right ventricular (RV) performance still remains technically challenging due to its anatomical and functional distinctiveness. The current guidelines for the echocardiographic quantification of RV function recommend using multiple indices to describe the RV in a thorough and comprehensive manner, such as RV index of myocardial performance, tricuspid annular plane systolic excursion, fractional area change, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'-wave), three-dimensional RV ejection fraction (3D RVEF), RV longitudinal strain (RVLS)/strain rate by speckle- tracking echocardiography (STE). Among these, the last one mentioned here is an innovative and a particularly promising tool that yields more precise information about complex regional and global RV mechanics. STE was initially designed to evaluate left ventricular function, but recently it has been introduced to assess RV performance, which is difficult due to its unique structure and physiology. Many studies have shown that both free wall and 6-segment RVLS present a stronger correlation with the RVEF assessed by cardiac magnetic resonance than conventional parameters and seem to be more sensitive in detecting myocardial dysfunction at an earlier, subclinical stage.

摘要

由于右心室(RV)在解剖结构和功能上的独特性,对其功能的评估在技术上仍然具有挑战性。目前关于超声心动图定量评估右心室功能的指南建议使用多个指标,以全面、综合的方式描述右心室,如心肌性能右心室指数、三尖瓣环平面收缩期位移、面积变化分数、多普勒组织成像得出的三尖瓣侧环收缩期速度(S波)、三维右心室射血分数(3D RVEF)、散斑追踪超声心动图(STE)测量的右心室纵向应变(RVLS)/应变率。其中,最后一项是一种创新且特别有前景的工具,能提供关于右心室复杂的局部和整体力学的更精确信息。STE最初是为评估左心室功能而设计的,但最近已被用于评估右心室功能,由于右心室独特的结构和生理特性,这一评估颇具难度。许多研究表明,游离壁和6节段右心室纵向应变与心脏磁共振评估的右心室射血分数的相关性均强于传统参数,并且在更早的亚临床阶段检测心肌功能障碍方面似乎更敏感。

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