Bidviene Jurate, Muraru Denisa, Maffessanti Francesco, Ereminiene Egle, Kovács Attila, Lakatos Bálint, Vaskelyte Jolanta-Justina, Zaliunas Remigijus, Surkova Elena, Parati Gianfranco, Badano Luigi P
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania.
Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Int J Cardiovasc Imaging. 2021 Apr;37(4):1289-1299. doi: 10.1007/s10554-020-02117-8. Epub 2021 Jan 3.
Our aim was to assess the regional right ventricular (RV) shape changes in pressure and volume overload conditions and their relations with RV function and mechanics. The end-diastolic and end-systolic RV endocardial surfaces were analyzed with three-dimensional echocardiography (3DE) in 33 patients with RV volume overload (rToF), 31 patients with RV pressure overload (PH), and 60 controls. The mean curvature of the RV inflow (RVIT) and outflow (RVOT) tracts, RV apex and body (both divided into free wall (FW) and septum) were measured. Zero curvature defined a flat surface, whereas positive or negative curvature indicated convexity or concavity, respectively. The longitudinal and radial RV wall motions were also obtained. rToF and PH patients had flatter FW (body and apex) and RVIT, more convex interventricular septum (body and apex) and RVOT than controls. rToF demonstrated a less bulging interventricular septum at end-systole than PH patients, resulting in a more convex shape of the RVFW (r = - 0.701, p < 0.0001), and worse RV longitudinal contraction (r = - 0.397, p = 0.02). PH patients showed flatter RVFW apex at end-systole compared to rToF (p < 0.01). In both groups, a flatter RVFW apex was associated with worse radial RV contraction (r = 0.362 in rToF, r = 0.482 in PH at end-diastole, and r = 0.555 in rToF, r = 0.379 in PH at end-systole, respectively). In PH group, the impairment of radial contraction was also related to flatter RVIT (r = 0.407) and more convex RVOT (r = - 0.525) at end-systole (p < 0.05). In conclusion, different loading conditions are associated to specific RV curvature changes, that are related to longitudinal and radial RV dysfunction.
我们的目的是评估压力和容量超负荷情况下右心室（RV）区域形状的变化及其与RV功能和力学的关系。采用三维超声心动图（3DE）分析了33例RV容量超负荷（rToF）患者、31例RV压力超负荷（PH）患者和60例对照者舒张末期和收缩末期的RV心内膜表面。测量了RV流入道（RVIT）和流出道（RVOT）、RV心尖和体部（均分为游离壁（FW）和室间隔）的平均曲率。零曲率定义为平面，而正曲率或负曲率分别表示凸面或凹面。还获得了RV壁的纵向和径向运动。与对照组相比，rToF和PH患者的FW（体部和心尖）和RVIT更平坦，室间隔（体部和心尖）和RVOT更凸。与PH患者相比，rToF患者收缩末期室间隔膨出较小，导致RVFW形状更凸（r = - 0.701，p < 0.0001），RV纵向收缩更差（r = - 0.397，p = 0.02）。与rToF相比，PH患者收缩末期RVFW心尖更平坦（p < 0.01）。在两组中，RVFW心尖较平坦均与RV径向收缩较差有关（rToF组舒张末期r = 0.362，PH组舒张末期r = 0.482；rToF组收缩末期r = 0.555，PH组收缩末期r = 0.379）。在PH组中，收缩末期径向收缩受损还与RVIT更平坦（r = 0.407）和RVOT更凸（r = - 0.525）有关（p < 0.05）。总之，不同的负荷条件与特定的RV曲率变化相关，这些变化与RV纵向和径向功能障碍有关。
