Wu Weichun, Liu Bingyang, Huang Min, Hsi David H, Niu LiLi, Tian Yue, Lin Jingru, Wang Jiangtao, Yang Shuai, Lu Hongquan, Xiong Changming, Zhu Zhenhui, Wang Hao
State Key Laboratory of Cardiovascular Disease, Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Pulmonary Vascular Disease Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2021 Jul 14;8:628610. doi: 10.3389/fcvm.2021.628610. eCollection 2021.
Four-dimensional automatic right ventricular quantification technology (4D auto-RVQ) is a new method that can simultaneously measure right ventricular (RV) structure and strain. The role of 4D auto-RVQ in determining RV function and hemodynamics is not clear. The role of 4D auto-RVQ in determining RV function and hemodynamics is not clear. We assessed the 4D auto-RVQ to measure right heart structure, function, and hemodynamics in patients with pulmonary hypertension (PHTN) correlated with right heart catheterization (RHC). We enrolled a prospective cohort of 103 patients with PHTN and 25 healthy controls between September 2017 and December 2018. All patients with PHTN underwent echocardiography and RHC. Patients were included if they underwent two-dimensional (2D) and 4D auto-RVQ echocardiographic sequences on the same day as RHC. We analyzed RV functional indices using 2D and 4D auto-RVQ analyses. We divided patients with PHTN into three groups according to echocardiographic image quality as follows: high ( = 24), average ( = 48), and poor ( = 4). Hemodynamic parameters were measured using RHC, including mean right atrial pressure, mean pulmonary arterial pressure, RV cardiac index (RV-CI), and pulmonary vascular resistance. There were significant differences in most 2D and 4D auto-RVQ parameters between patients with PHTN and healthy controls. Interobserver variability showed significant agreement with 4D auto-RVQ for most measurements except for 4D end-diastolic volume. Indices measured by auto 4D-RVQ in the high-quality image group had a good correlation with RHC but not in the average- and poor-quality image group. Mid-RV diameter showed the best predictive power for the right RV-CI [area under the curve (AUC) 0.935; 95% confidence interval (CI), 0.714-0.997; < 0.001]. RV end-systolic volume >121.50 mL had a 71.43% sensitivity and a 100% specificity to predict right RV-CI (AUC, 0.890; 95% CI, 0.654-0.986; < 0.001). 4D auto-RVQ may be used to estimate RV function and some hemodynamic changes compared with RHC in PHTN patients with high image quality. Furthermore, a large sample of the study is needed to evaluate RV function by 4D auto-RVQ in PHTN patients with average image quality.
四维自动右心室定量技术（4D自动RVQ）是一种能够同时测量右心室（RV）结构和应变的新方法。4D自动RVQ在确定RV功能和血流动力学方面的作用尚不清楚。我们评估了4D自动RVQ在与右心导管检查（RHC）相关的肺动脉高压（PHTN）患者中测量右心结构、功能和血流动力学的情况。我们在2017年9月至2018年12月期间纳入了103例PHTN患者的前瞻性队列和25名健康对照者。所有PHTN患者均接受了超声心动图检查和RHC。如果患者在RHC当天接受了二维（2D）和4D自动RVQ超声心动图序列检查，则被纳入研究。我们使用2D和4D自动RVQ分析来分析RV功能指标。我们根据超声心动图图像质量将PHTN患者分为三组：高质量（=24）、中等质量（=48）和低质量（=4）。使用RHC测量血流动力学参数，包括平均右心房压、平均肺动脉压、RV心脏指数（RV-CI）和肺血管阻力。PHTN患者和健康对照者之间的大多数2D和4D自动RVQ参数存在显著差异。观察者间变异性显示，除4D舒张末期容积外，4D自动RVQ的大多数测量结果具有显著一致性。在高质量图像组中，通过自动4D-RVQ测量的指标与RHC具有良好的相关性，但在中等质量和低质量图像组中则不然。右心室中部直径对右RV-CI的预测能力最佳[曲线下面积（AUC）为0.935；95%置信区间（CI），0.714-0.997；P<0.001]。RV收缩末期容积>121.50 mL预测右RV-CI的敏感性为71.43%，特异性为100%（AUC，0.890；95%CI，0.654-0.986；P<0.001）。与RHC相比，4D自动RVQ可用于估计高质量图像的PHTN患者的RV功能和一些血流动力学变化。此外，需要大量样本研究来评估中等质量图像的PHTN患者通过4D自动RVQ评估RV功能的情况。
