Werther Evaldsson A, Ingvarsson A, Smith J G, Rådegran G, Roijer A, Waktare J, Ostenfeld E, Meurling C
Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund University, Lund, Sweden.
Liverpool Heart and Chest Hospital, Liverpool, UK.
Clin Physiol Funct Imaging. 2019 Mar;39(2):168-176. doi: 10.1111/cpf.12552. Epub 2018 Oct 30.
Right ventricular (RV) systolic function is an important determinant of outcome in patients with pulmonary hypertension (PH). Conventional echocardiographic measures of RV are mainly based on longitudinal contractility. Recently, measurement of RV global longitudinal strain derived from multiple windows (RVGLS) has emerged as an option but has not been well evaluated. The aim of the present study was to evaluate which echocardiographic RV function parameter correlates best with RV ejection fraction derived from cardiac magnetic resonance imaging (RVEF ).
Fifty-five patients evaluated for PH underwent RV assessment with echocardiography and CMR. Conventional echocardiographic parameters of RV function including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S'), RV fractional area change (RVFAC) and RV index of myocardial performance (RIMP). RVGLS was measured from three separate apical views using a 17-segment model and strain from the lateral free wall was calculated separately (RVfree). The study included 55 patients, whereas assessment of RVGLS could be obtained in 29 patients. The Pearson correlation coefficient with RVEF was strong for RVGLS (r = 0·814, P<0·001) and RVfree (r = 0·778, P<0·001), modest for RVFAC (r = 0·681, P<0·001), TAPSE (r = 0·592, P<0·001) and RIMP (r=-0·521, P<0·01), and weak for S' (r = 0·385, P<0·01).
The echocardiographic RV measures, RVGLS and RVfree correlated well with RVEF , whereas correlation with TAPSE, RIMP and S' was unsatisfactory. Our findings suggest that RVGLS and RVfree are the preferred echocardiographic methods for clinical practice. RVfree is easiest to perform but RVGLS could provide incremental value in selected patients.
右心室（RV）收缩功能是肺动脉高压（PH）患者预后的重要决定因素。传统超声心动图对右心室的测量主要基于纵向收缩性。近年来，从多个切面测量右心室整体纵向应变（RVGLS）成为一种选择，但尚未得到充分评估。本研究的目的是评估哪种超声心动图右心室功能参数与心脏磁共振成像得出的右心室射血分数（RVEF）相关性最佳。
55例接受PH评估的患者接受了超声心动图和心脏磁共振成像的右心室评估。右心室功能的传统超声心动图参数包括三尖瓣环平面收缩期位移（TAPSE）、三尖瓣环收缩期速度（S'）、右心室面积变化分数（RVFAC）和右心室心肌做功指数（RIMP）。使用17节段模型从三个独立的心尖切面测量RVGLS，并分别计算侧壁的应变（RVfree）。该研究纳入55例患者，其中29例可获得RVGLS评估。RVGLS（r = 0·814，P<0·001）和RVfree（r = 0·778，P<0·001）与RVEF的Pearson相关系数较强，RVFAC（r = 0·681，P<0·001）、TAPSE（r = 0·592，P<0·001）和RIMP（r=-0·521，P<0·01）的相关性中等，S'（r = 0·385，P<0·01）的相关性较弱。
超声心动图测量指标RVGLS和RVfree与RVEF相关性良好，而与TAPSE、RIMP和S'的相关性不令人满意。我们的研究结果表明，RVGLS和RVfree是临床实践中首选的超声心动图方法。RVfree最易于实施，但RVGLS可为特定患者提供更多价值。
