使用三维超声心动图衍生网格模型的右心室容积-应变环：在接受不同类型心脏直视手术患者中的概念验证应用
Right ventricular volume-strain loops using 3D echocardiography-derived mesh models: proof-of-concept application on patients undergoing different types of open-heart surgery.
作者信息
Keller Marius, Puhlmann Ann-Sophie, Heller Tim, Rosenberger Peter, Magunia Harry
机构信息
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Tuebingen, Germany.
出版信息
Quant Imaging Med Surg. 2022 Jul;12(7):3679-3691. doi: 10.21037/qims-21-1204.
BACKGROUND
Right ventricular (RV) function can be quantified by right heart catheterization-derived pressure-volume loops. While this technique is invasive, echocardiography-based volume-strain loops (VSLs) potentially reflect a non-invasive alternative. In this study, an approach to generate VSLs from volume and multidimensional strain data of 3D echocardiography-derived RV mesh models is evaluated with regard to feasibility and reproducibility.
METHODS
In a retrospective cohort study design, 3D intraoperative transesophageal echocardiograms of twenty-three patients undergoing aortic valve surgery (AVS) and eighteen patients undergoing off-pump coronary artery bypass (OPCAB) grafting were available prior to sternotomy and after sternal closure. RV meshes were generated using 3D speckle-tracking. Custom-made software quantified the meshes' volumes, global longitudinal (RV-GLS) and global circumferential strain (RV-GCS) for VSL generation. Linear regression of systolic VSLs yielded slopes, intercepts and systolic areas. Polynomial regression of two orders was used to analyze systolic-diastolic coupling at 10% increments of the RV end-diastolic volume (RVEDV). Reproducibility was analyzed by fourfold double-measurements of four datasets.
RESULTS
VSL calculation was feasible from all included 3D datasets. RV-GLS remained unaltered, but RV-GCS worsened in AVS [abs. diff. (∆) 3.9%, P<0.01] and OPCAB patients (∆4.5%, P<0.001). While RV-GCS systolic areas were markedly reduced at the end of AVS (∆268mL%, P<0.01) and OPCAB (∆185mL%, P<0.001), RV-GCS slopes did not change. Systolic-diastolic uncoupling was not observed, but in trend, decreased diastolic RV-GCS after AVS (P=0.06) and increased diastolic RV-GCS after OPCAB (P=0.06) were observed. Intraclass correlation coefficients (0.84-0.98) and coefficients of variation (6.4-11.8%) indicated good reproducibility.
CONCLUSIONS
RV VSL generation using 3D echocardiography-derived mesh models is feasible. Longitudinal and circumferential strain vectors yield intrinsically different VSL indices. In future investigations, VSLs of multidimensional strains could provide further insight into periprocedural changes of RV mechanics.
背景
右心室（RV）功能可通过右心导管检查得出的压力-容积环进行量化。虽然该技术具有侵入性，但基于超声心动图的容积-应变环（VSL）可能是一种非侵入性替代方法。在本研究中，评估了一种从三维超声心动图衍生的右心室网格模型的容积和多维应变数据生成VSL的方法的可行性和可重复性。
方法
在一项回顾性队列研究设计中，23例行主动脉瓣手术（AVS）的患者和18例行非体外循环冠状动脉搭桥术（OPCAB）的患者的三维术中经食管超声心动图在胸骨切开术前和胸骨闭合后均可获得。使用三维斑点追踪生成右心室网格。定制软件对网格的容积、整体纵向（RV-GLS）和整体圆周应变（RV-GCS）进行量化以生成VSL。收缩期VSL的线性回归得出斜率、截距和收缩期面积。使用二阶多项式回归以右心室舒张末期容积（RVEDV）增加10%的幅度分析收缩期-舒张期耦合。通过对四个数据集进行四次重复双测量来分析可重复性。
结果
从所有纳入的三维数据集中计算VSL是可行的。在AVS患者[绝对差值（∆）3.9%，P<0.01]和OPCAB患者（∆4.5%，P<0.001）中，RV-GLS保持不变，但RV-GCS恶化。虽然在AVS结束时（∆268mL%，P<0.01）和OPCAB结束时（∆185mL%，P<0.001），RV-GCS收缩期面积显著减小，但RV-GCS斜率未改变。未观察到收缩期-舒张期解耦，但在趋势上，观察到AVS后舒张期RV-GCS降低（P=0.06）和OPCAB后舒张期RV-GCS增加（P=0.06）。组内相关系数（0.84 - 0.98）和变异系数（6.4 - 11.8%）表明具有良好的可重复性。
结论
使用三维超声心动图衍生的网格模型生成右心室VSL是可行的。纵向和圆周应变向量产生本质上不同的VSL指标。在未来的研究中，多维应变的VSL可提供对右心室力学围手术期变化的进一步见解。
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