Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois.
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
JAMA Cardiol. 2019 Sep 1;4(9):936-944. doi: 10.1001/jamacardio.2019.2424.
Before the introduction of 3-dimensional echocardiography, estimations of right ventricular (RV) size and function by echocardiography were limited to regional approximations of global function. This review describes the novel application of 3-dimensional echocardiography in the assessment of RV size and function, in juxtaposition with what is currently available using 2-dimensional echocardiography.
Two-dimensional echocardiographic evaluation of RV size and function includes measures of systolic basal longitudinal excursion (tricuspid annular plane systolic excursion and peak systolic velocity), fractional area change, and free-wall strain, all of which are measured from a single tomographic imaging plane: the RV-focused view. Given this limitation, clinical situations in which more accurate assessment of the RV or close patient follow-up were required were resolved with the use of cardiovascular magnetic resonance, computed tomography, and other modalities to obtain global measures of size and function (ie, volume and ejection fraction). With 3-dimensional echocardiography, both volume and ejection fraction assessments of the RV are possible with an accuracy and reproducibility close to that of cardiovascular magnetic resonance imaging. Further, 3-dimensional RV data sets can be cropped, sliced, and rotated to assess device leads, tricuspid valve leaflets, and RV wall-motion abnormalities. The 3-dimensional RV data set opens the horizon to endless possibilities for further exploration of novel parameters, including 3-dimensional RV shape and 3-dimensional RV deformation analysis.
The use of 3-dimensional echocardiography overcomes many of the limitations associated with conventional 2-dimensional echocardiography and has the potential to provide the detailed information required for the complex clinical decision-making that requires accurate, quantitative information about the RV.
在引入三维超声心动图之前，超声心动图对右心室 (RV) 大小和功能的评估仅限于对整体功能的区域近似。本综述描述了三维超声心动图在 RV 大小和功能评估中的新应用，与目前二维超声心动图可用的方法并列。
二维超声心动图评估 RV 大小和功能包括收缩期基底纵向位移（三尖瓣环平面收缩期位移和收缩期峰值速度）、面积分数变化和游离壁应变的测量，所有这些都是从单个断层成像平面（RV 焦点视图）进行测量。鉴于这种局限性，需要更准确评估 RV 或密切随访患者的临床情况，使用心血管磁共振、计算机断层扫描和其他方式获得大小和功能的整体测量值（即体积和射血分数）来解决。使用三维超声心动图，RV 的容量和射血分数评估都可以达到与心血管磁共振成像相近的准确性和可重复性。此外，三维 RV 数据集可以裁剪、切片和旋转，以评估设备导联、三尖瓣瓣叶和 RV 壁运动异常。三维 RV 数据集为进一步探索新参数打开了无限可能，包括三维 RV 形状和三维 RV 变形分析。
三维超声心动图的使用克服了与传统二维超声心动图相关的许多限制，并有可能提供复杂临床决策所需的详细信息，这些决策需要有关 RV 的准确、定量信息。
