Okada Kazunori, Kaga Sanae, Tsujita Kosuke, Sakamoto Yoichi, Masauzi Nobuo, Mikami Taisei
Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-Ku, Sapporo, 060-0812, Japan.
Medical Corporation Hokuseki Group, Kitanodai Clinic, 13-2 Kyouei-cho,1, Kitahirosima, 061-1113, Japan.
Int J Cardiovasc Imaging. 2019 Jul;35(7):1211-1219. doi: 10.1007/s10554-019-01536-6. Epub 2019 Jan 25.
Sigmoid-shaped ventricular septum (SS), a frequently encountered minor abnormality in echocardiographic examinations of the elderly, may have some influence on RV shape. We aimed to determine the influence of SS on the accuracy of the 6 RV linear diameter measurements in the light of three-dimensional echocardiographic (3DE) RV volume. The aorto-septal angle (ASA) was measured in the parasternal long-axis view using two-dimensional echocardiography (2DE) as an index of SS in 70 patients without major cardiac abnormalities who were subdivided into 35 with SS (ASA ≤ 120°) and 35 without SS (NSS). We measured RV end-diastolic volume (RVEDV) using 3DE; in addition, using 2DE, we measured basal RV diameter, mid-cavity diameter, longitudinal diameter and end-diastolic area in the apical four-chamber view; proximal RV outflow tract (RVOT) diameter in the parasternal long-axis view; and proximal and distal RVOT diameters in the parasternal short-axis view. RVEDV did not differ between the SS and NSS groups. The SS group had greater basal RV diameter and proximal and distal RVOT diameters than the NSS group. RV mid-cavity diameter, longitudinal diameter, and end-diastolic area did not differ between the groups. Among the 2DE parameters of RV size, RV end-diastolic area was most strongly correlated with RVEDV (r = 0.67), followed by RV mid-cavity diameter (r = 0.58). When SS is present, the echocardiographic basal RV diameter and RVOT diameters overestimate RV size, and the measurement of RV end-diastolic area and mid-cavity diameter more correctly reflect 3D RV volume.
S形室间隔（SS）是老年人超声心动图检查中常见的轻微异常，可能对右心室（RV）形态有一定影响。我们旨在根据三维超声心动图（3DE）测量的RV容积，确定SS对6项RV线性直径测量准确性的影响。使用二维超声心动图（2DE）在胸骨旁长轴视图中测量主动脉-室间隔角（ASA），作为SS的指标，纳入70例无重大心脏异常的患者，将其分为35例有SS（ASA≤120°）和35例无SS（NSS）的患者。我们使用3DE测量RV舒张末期容积（RVEDV）；此外，使用2DE，我们在心尖四腔视图中测量RV基底直径、中腔直径、纵向直径和舒张末期面积；在胸骨旁长轴视图中测量RV流出道近端（RVOT）直径；在胸骨旁短轴视图中测量RVOT近端和远端直径。SS组和NSS组的RVEDV无差异。SS组的RV基底直径以及RVOT近端和远端直径均大于NSS组。两组之间的RV中腔直径、纵向直径和舒张末期面积无差异。在RV大小的2DE参数中，RV舒张末期面积与RVEDV的相关性最强（r = 0.67），其次是RV中腔直径（r = 0.58）。当存在SS时，超声心动图测量的RV基底直径和RVOT直径会高估RV大小，而RV舒张末期面积和中腔直径的测量更能准确反映3D RV容积。
