三维超声心动图右心室容积测量在儿童中的验证和参考值：一项多中心研究。
Validation and Reference Values for Three-Dimensional Echocardiographic Right Ventricular Volumetry in Children: A Multicenter Study.
机构信息
Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
Center for Congenital Heart Defects, Heart and Diabetes Center North-Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany; Clinic for Anesthesiology, Intensive Care and Pain Therapy, North Rhine-Westphalia, Ruhr-University of Bochum, University Medical Center Knappschaftskrankenhaus Bochum, Langendreer, Bochum, Germany.
出版信息
J Am Soc Echocardiogr. 2018 Sep;31(9):1050-1063. doi: 10.1016/j.echo.2018.03.010. Epub 2018 Jun 19.
BACKGROUND
Functional assessment of the right ventricle using real-time three-dimensional echocardiography (RT3DE) has fundamental relevance in young patients with congenital heart disease. Reference values for the pediatric population are scarce. This multicenter study was designed to (1) validate new evaluation software for RT3DE and (2) establish pediatric reference values.
METHODS
For validation, right ventricular (RV) end-diastolic volume (EDV) and end-systolic volume (ESV) were determined from real-time three-dimensional echocardiographic data sets of 38 subjects (n = 17 healthy individuals and n = 21 patients with congenital heart disease) using new dedicated evaluation software (RV-Function 2.0) and compared with cardiac magnetic resonance investigations of the same patient cohort. In a prospective multicenter design, 360 real-time three-dimensional echocardiographic data sets of healthy children (172 girls) were analyzed. To create reference centiles, the cohort was subdivided into group I (children <7 years of age, n = 136 [female and male]), group II (girls 7-18 years of age, n = 106), and group III (boys 7-18 years of age, n = 118).
RESULTS
Using RT3DE, RV volumes were slightly higher than using cardiac magnetic resonance (EDV, 0.8 ± 5.8% [limits of agreement, -10.8% to 12.5%; r = 0.993]; ESV, 2.0 ± 13.1% [limits of agreement, -24.2% to 28.2%; r = 0.989). Reproducibility was promising (intraobserver variability, 3.9 ± 11.4% for EDV and -1.7 ± 13.4% for ESV [intraclass correlation coefficient range, 0.94-0.98]; interobserver variability, 1.9 ± 11.8% for EDV and -0.3 ± 22.8% for ESV [intraclass correlation coefficient range, 0.85-0.96]). Regarding functional parameters, no significant gender differences were found among children in group I. In contrast, children in groups II and III differed in RV volumes, dimensional parameters, and tricuspid annular plane systolic excursion (P < .005); the children did not differ in deformation parameters. Feasibility was 90%.
CONCLUSIONS
RT3DE yields accurate and reproducible RV volumes. The calculated percentile curves may facilitate the clinical use of RT3DE to analyze RV function in children.
背景
实时三维超声心动图（RT3DE）对先天性心脏病的年轻患者的右心室功能评估具有重要意义。儿科人群的参考值很少。本多中心研究旨在：（1）验证 RT3DE 的新评估软件，（2）建立儿科参考值。
方法
为了进行验证，使用新的专用评估软件（RV-Function 2.0）从 38 名受试者（17 名健康个体和 21 名先天性心脏病患者）的实时三维超声心动图数据集确定右心室（RV）舒张末期容积（EDV）和收缩末期容积（ESV），并与同一患者队列的心脏磁共振检查进行比较。在一项前瞻性多中心设计中，分析了 360 名健康儿童（172 名女孩）的实时三维超声心动图数据集。为了创建参考百分位数，将队列分为三组：I 组（年龄<7 岁的儿童，n=136[女性和男性]）、II 组（年龄 7-18 岁的女孩，n=106）和 III 组（年龄 7-18 岁的男孩，n=118）。
结果
使用 RT3DE，RV 容积略高于心脏磁共振（EDV，0.8±5.8%[协议范围，-10.8%至 12.5%；r=0.993]；ESV，2.0±13.1%[协议范围，-24.2%至 28.2%；r=0.989]）。可重复性有很大希望（EDV 的观察者内变异性为 3.9±11.4%，ESV 的观察者内变异性为-1.7±13.4%[组内相关系数范围，0.94-0.98]；EDV 的观察者间变异性为 1.9±11.8%，ESV 的观察者间变异性为-0.3±22.8%[组内相关系数范围，0.85-0.96]）。关于功能参数，I 组中儿童的性别差异不明显。相比之下，II 组和 III 组的儿童在 RV 容积、二维参数和三尖瓣环平面收缩期位移（P<0.005）方面存在差异；儿童的变形参数无差异。可行性为 90%。
结论
RT3DE 可准确且可重复地测量 RV 容积。计算出的百分位曲线可能有助于 RT3DE 在儿童 RV 功能分析中的临床应用。
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