Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
J Am Soc Echocardiogr. 2017 Dec;30(12):1203-1213. doi: 10.1016/j.echo.2017.08.007. Epub 2017 Nov 1.
Accurate assessment of global and regional right ventricular (RV) systolic function is challenging. The aims of this study were to confirm the reliability and feasibility of a three-dimensional (3D) speckle-tracking echocardiography (STE) system, using comparison with cardiac magnetic resonance imaging (CMR), and to assess the contribution of regional RV function to global function.
In a retrospective, cross-sectional study setting, RV volumetric data were studied in 106 patients who were referred for both CMR and 3D echocardiography within 1 month. Three-dimensional STE-derived area strain, longitudinal strain, and circumferential strain were assessed as global, inlet, outflow, apical, and septal segments.
Seventy-five patients (70%) had adequate 3D echocardiographic data. RV measurements derived from 3D STE and CMR were closely related (RV end-diastolic volume, R = 0.84; RV end-systolic volume, R = 0.83; RV ejection fraction [RVEF], R = 0.70; P < .001 for all). RVEF and RV end-diastolic volume from 3D STE were slightly but significantly smaller than CMR values (mean differences, -2% and -10 mL for RVEF and RV end-diastolic volume, respectively). Among conventional echocardiographic parameters for RV function (tricuspid annular plane systolic excursion, fractional area change, S' of the tricuspid annulus, RV free wall two-dimensional longitudinal strain), only fractional area change was significantly related to RVEF (r = 0.34, P = .003). Among segmental 3D strain variables, inlet area strain (r = -0.56, P < .001) and outflow circumferential strain (r = -0.42, P < .001) were independent factors associated with CMR-derived RVEF.
RV volume and RVEF determined by 3D STE were comparable with CMR measurements. Regional RV wall motion showed that heterogeneous segmental deformations affect global RV function differently; specifically, inlet area strain and outflow circumferential strain were significant factors associated with RVEF in patients with underlying heart diseases.
准确评估整体和局部右心室（RV）收缩功能具有挑战性。本研究的目的是通过与心脏磁共振成像（CMR）比较，确认三维（3D）斑点追踪超声心动图（STE）系统的可靠性和可行性，并评估局部 RV 功能对整体功能的贡献。
在回顾性、横断面研究中，对 106 例在 1 个月内同时接受 CMR 和 3D 超声心动图检查的患者的 RV 容积数据进行了研究。使用 3D STE 评估整体、流入、流出、心尖和间隔节段的面积应变、纵向应变和周向应变。
75 例患者（70%）有足够的 3D 超声心动图数据。3D STE 衍生的 RV 测量值与 CMR 密切相关（RV 舒张末期容积，R=0.84；RV 收缩末期容积，R=0.83；RV 射血分数[RVEF]，R=0.70；P<.001 均为）。3D STE 衍生的 RVEF 和 RV 舒张末期容积略小于 CMR 值（平均差异分别为-2%和-10 mL）。在 RV 功能的常规超声心动图参数（三尖瓣环平面收缩期位移、节段面积变化、三尖瓣环 S'、RV 游离壁二维纵向应变）中，只有节段面积变化与 RVEF 显著相关（r=0.34，P=0.003）。在节段 3D 应变变量中，流入区面积应变（r=-0.56，P<.001）和流出周向应变（r=-0.42，P<.001）是与 CMR 衍生的 RVEF 相关的独立因素。
3D STE 确定的 RV 容积和 RVEF 与 CMR 测量值相当。局部 RV 壁运动表明，不均匀的节段变形以不同的方式影响整体 RV 功能；具体而言，流入区面积应变和流出周向应变是基础心脏病患者 RVEF 的重要相关因素。
