Zaidi Abbas, Knight Daniel S, Augustine Daniel X, Harkness Allan, Oxborough David, Pearce Keith, Ring Liam, Robinson Shaun, Stout Martin, Willis James, Sharma Vishal
University Hospital of Wales, Cardiff, UK
Royal Free London NHS Foundation Trust, London, UK
Echo Res Pract. 2020 Feb 27;7(1):G19-G41. doi: 10.1530/ERP-19-0051.
The structure and function of the right side of the heart is influenced by a wide range of physiological and pathological conditions. Quantification of right heart parameters is important in a variety of clinical scenarios including diagnosis, prognostication, and monitoring response to therapy. Although echocardiography remains the first-line imaging investigation for right heart assessment, published guidance is relatively sparse in comparison to that for the left ventricle. This guideline document from the British Society of Echocardiography describes the principles and practical aspects of right heart assessment by echocardiography, including quantification of chamber dimensions and function, as well as assessment of valvular function. While cut-off values for normality are included, a disease-oriented approach is advocated due to the considerable heterogeneity of structural and functional changes seen across the spectrum of diseases affecting the right heart. The complex anatomy of the right ventricle requires special considerations and echocardiographic techniques, which are set out in this document. The clinical relevance of right ventricular diastolic function is introduced, with practical guidance for its assessment. Finally, the relatively novel techniques of three-dimensional right ventricular echocardiography and right ventricular speckle tracking imaging are described. Despite these techniques holding considerable promise, issues relating to reproducibility and inter-vendor variation have limited their clinical utility to date.
心脏右侧的结构和功能受多种生理和病理状况影响。在包括诊断、预后评估及监测治疗反应等多种临床场景中，对右心参数进行量化十分重要。尽管超声心动图仍是右心评估的一线影像学检查方法，但与左心室评估的相关指南相比，已发表的指南相对较少。英国超声心动图学会的这份指南文件阐述了通过超声心动图进行右心评估的原则和实际操作，包括腔室大小和功能的量化以及瓣膜功能评估。虽然包含了正常范围的临界值，但鉴于影响右心的一系列疾病中结构和功能变化存在显著异质性，故提倡采用以疾病为导向的方法。右心室复杂的解剖结构需要特殊考量及超声心动图技术，本文对此进行了阐述。文中介绍了右心室舒张功能的临床意义，并给出了评估的实用指南。最后，描述了三维右心室超声心动图和右心室斑点追踪成像等相对新颖的技术。尽管这些技术前景广阔，但迄今为止，与可重复性和不同厂家设备差异相关的问题限制了它们的临床应用。
