Department of Cardiology, Erasmus MC Thorax Center, Rotterdam, The Netherlands.
Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
Int J Cardiovasc Imaging. 2021 Oct;37(10):2905-2915. doi: 10.1007/s10554-021-02273-5. Epub 2021 May 18.
In patients with repaired Tetralogy of Fallot (ToF), detailed assessment of right ventricular (RV) function is important for management and timing of possible pulmonary valve re-intervention. The aim of this study was to evaluate RV function using two-dimensional multi-plane echocardiography (2D MPE), a novel four-wall imaging method obtained from one apical acoustic window utilising electronic plane rotation. In sixty-two ToF patients (aged - 28 [22, 39] years, 65% male), systolic function of four different RV walls (lateral, anterior, inferior and inferior coronal) were evaluated using MPE. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity (RV-S') and RV wall longitudinal strain (RV-LS) measurements were compared with those of matched healthy individuals. 2D MPE measurements were highly feasible across the four RV walls (93.5-100% for TAPSE/S'; 66.1-95.1% for RVLS) and could be performed more reliably than 3D RV ejection fraction (RVEF - 56.5%). All functional values were significantly reduced when compared to the control group (p < 0.001). Higher RV-LS values were seen in the lateral (- 17.8 ± 4.5%) and inferior (- 17.8 ± 4.2%) walls compared to the anterior (- 15.9 ± 3.8%) and inferior coronal (- 15.1 ± 3.9%) walls. 3D RVEF correlated strongest with RV-LS values from the lateral (r - 0.50; p = 0.002) and anterior walls (r - 0.74; p < 0.001) and furthermore the four-wall average (r - 0.57; p = 0.001). 2D MPE evaluation of the RV is highly feasible in ToF patients. This novel method provides new insights into regional RV wall function, enabling a more comprehensive and quantitative approach to RV assessment in daily clinical practice.
在法洛四联症（ToF）修复患者中，详细评估右心室（RV）功能对于管理和可能的肺动脉瓣再干预时机非常重要。本研究的目的是使用二维多平面超声心动图（2D MPE）评估 RV 功能，这是一种从一个心尖声学窗口获得的新型四壁成像方法，利用电子平面旋转。在 62 例 ToF 患者（年龄 28 [22, 39] 岁，65%为男性）中，使用 MPE 评估了四个不同 RV 壁（侧壁、前壁、下壁和下冠状壁）的收缩功能。比较了三尖瓣环平面收缩期位移（TAPSE）、三尖瓣环收缩期峰值速度（RV-S'）和 RV 壁纵向应变（RV-LS）测量值与匹配的健康个体的测量值。2D MPE 测量在四个 RV 壁均高度可行（TAPSE/S'为 93.5-100%；RV-LS 为 66.1-95.1%），并且比 3D RV 射血分数（RVEF）更可靠（-56.5%）。与对照组相比，所有功能值均显著降低（p<0.001）。与前壁（-15.9±3.8%）和下冠状壁（-15.1±3.9%）相比，侧壁（-17.8±4.5%）和下壁（-17.8±4.2%）的 RV-LS 值更高。3D RVEF 与侧壁（r=-0.50；p=0.002）和前壁（r=-0.74；p<0.001）以及四个壁的平均值（r=-0.57；p=0.001）的 RV-LS 值相关性最强。在 ToF 患者中，RV 的 2D MPE 评估具有高度可行性。这种新方法提供了 RV 壁功能的新见解，使 RV 评估能够在日常临床实践中采用更全面和定量的方法。
