University of Chicago, Chicago, Illinois.
MedStar Health Research Institute, Washington, District of Columbia.
J Am Soc Echocardiogr. 2023 Aug;36(8):858-866.e1. doi: 10.1016/j.echo.2023.04.011. Epub 2023 Apr 20.
Normal values for three-dimensional (3D) right ventricular (RV) size and function are not well established, as they originate from small studies that involved predominantly white North American and European populations, did not use RV-focused views, and relied on older 3D RV analysis software. The World Alliance Societies of Echocardiography study was designed to generate reference ranges for normal subjects around the world. The aim of this study was to assess the worldwide capability of 3D imaging of the right ventricle and report size and function measurements, including their dependency on age, sex, and ethnicity.
Healthy subjects free of cardiac, pulmonary, and renal disease were prospectively enrolled at 19 centers in 15 countries, representing six continents. Three-dimensional wide-angle RV data sets were obtained and analyzed using dedicated RV software (TomTec) to measure end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume, and ejection fraction (EF). Results were categorized by sex, age (18-40, 41-65, and >65 years) and ethnicity.
Of the 2,007 subjects with attempted 3D RV acquisitions, 1,051 had adequate image quality for confident measurements. Upper and lower limits for body surface area-indexed EDV, ESV, and EF were 48 and 95 mL/m, 19 and 43 mL/m, and 44% and 58%, respectively, for men and 42 and 81 mL/m, 16 and 36 mL/m, and 46% and 61%, respectively, for women. Men had significantly larger EDVs, ESVs, and stroke volumes (even after body surface area indexing) and lower EFs than women (P < .05). EDV and ESV did not show any meaningful differences among age groups. Three-dimensional RV volumes were smallest in Asians.
Reliability of 3D RV acquisition is low worldwide, underscoring the importance of future improvements in imaging techniques. Sex and race must be taken into consideration in the assessment of both RV volumes and EF.
目前尚未建立三维（3D）右心室（RV）大小和功能的正常值，因为这些值来源于主要为北美和欧洲白种人群的小样本研究，这些研究未使用 RV 重点视图，并且依赖于较旧的 3D RV 分析软件。世界超声心动图联盟协会研究旨在为全球健康人群生成参考范围。本研究的目的是评估全球 3D 成像评估右心室的能力，并报告其大小和功能测量值，包括这些值与年龄、性别和种族的相关性。
前瞻性地在 15 个国家的 19 个中心招募无心脏、肺部和肾脏疾病的健康受试者。使用专用 RV 软件（TomTec）获取并分析 3D 广角 RV 数据集，以测量舒张末期容积（EDV）、收缩末期容积（ESV）、心搏量和射血分数（EF）。根据性别、年龄（18-40、41-65 和 >65 岁）和种族对结果进行分类。
在 2007 名尝试进行 3D RV 采集的受试者中，有 1051 名受试者的图像质量足以进行有信心的测量。按体表面积指数划分，男性的 EDV、ESV 和 EF 的上限和下限分别为 48 和 95 mL/m、19 和 43 mL/m、44%和 58%，女性分别为 42 和 81 mL/m、16 和 36 mL/m、46%和 61%。男性的 EDV、ESV 和心搏量明显大于女性（P<.05），EF 则较低。EDV 和 ESV 在年龄组之间没有明显差异。亚洲人的 3D RV 容积最小。
全球范围内 3D RV 采集的可靠性较低，这突显出未来改进成像技术的重要性。在评估 RV 容积和 EF 时，必须考虑性别和种族。
