Huang Weiting, Hodovan James, Sharma Avneesh, Morello Matteo, Varli Onur, Gholson Bethany, Lindner Jonathan R
Cardiovascular Division and Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia.
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
J Am Soc Echocardiogr. 2025 Mar;38(3):187-194. doi: 10.1016/j.echo.2024.11.011. Epub 2024 Dec 17.
When assessing right ventricular (RV) function by echocardiography, some discordance between the deformational indices is predicted on the basis of the influence of RV length. RV free wall longitudinal strain (RVFWS) is relatively independent of RV length, whereas tricuspid annular plane systolic excursion (TAPSE) reflects the strain-length product. Systolic annular velocity (s'; distance over time) is also likely to be influenced by length. The aim of this study was to test the hypothesis that indexing TAPSE and s' to RV length would lead to better congruency with RVFWS.
Two separate cohorts were identified from retrospective data: (1) subjects with normal cardiac function (n = 75) and (2) a cohort with high likelihood of potential RV dysfunction determined by the study indication of either pulmonary hypertension or pulmonary embolism (n = 50). RV functional indices of TAPSE, RV s', RVFWS, and fractional area change were verified and remeasured by an expert. Correlations and concordance maps between RVFWS and either TAPSE or RV s' were made with and without indexing the latter measurements to RV length. Predictive accuracy for detecting abnormal RVFWS were made using receiver operating characteristics analysis.
In normal subjects, indexing either TAPSE or RV s' to RV length led to an improvement in the correlation coefficient (from 0.59 to 0.68 for TAPSE, from 0.41 to 0.58 for RV s') and the variance (F statistic from 64.9 to 105.3 for TAPSE from 24.7 to 63.9 for RV s') for correlations with RVFWS. In all subjects, categorical concordance with RVFWS was improved by indexing TAPSE and s' to RV length primarily because of correction of underperformance to detect abnormal RVFWS in subjects with long RV length and better discrimination as normal for subjects with short RV length. Indexing to RV length improved the C statistic for detecting abnormal RVFWS for both TAPSE (0.80 vs 0.87, P = .03) and RV s' (0.65 vs 0.77, P = .002).
Indexing TAPSE and RV s' to RV length improves concordance of these deformational measurements with RVFWS and their ability to classify those with RV dysfunction according to RVFWS. Indexing TAPSE and RV s' to length is particularly effective for interpreting paradoxical information such as low TAPSE and s' in normal patients with short RV length and those with increased RV length who have normal TAPSE and s' values but other evidence of RV dysfunction.
在通过超声心动图评估右心室（RV）功能时，基于RV长度的影响，预计变形指数之间会存在一些不一致。RV游离壁纵向应变（RVFWS）相对独立于RV长度，而三尖瓣环平面收缩期位移（TAPSE）反映应变-长度乘积。收缩期环速度（s'；距离除以时间）也可能受长度影响。本研究的目的是检验以下假设：将TAPSE和s'除以RV长度进行指数化处理会使它们与RVFWS的一致性更好。
从回顾性数据中确定了两个独立的队列：（1）心功能正常的受试者（n = 75）和（2）由肺动脉高压或肺栓塞的研究指征确定有潜在RV功能障碍高可能性的队列（n = 50）。TAPSE、RV s'、RVFWS和面积变化分数等RV功能指标由一名专家进行核实和重新测量。在对TAPSE或RV s'测量值不进行和进行RV长度指数化处理的情况下，分别绘制RVFWS与TAPSE或RV s'之间的相关性和一致性图。使用受试者工作特征分析来确定检测异常RVFWS的预测准确性。
在正常受试者中，将TAPSE或RV s'除以RV长度进行指数化处理后，与RVFWS的相关系数得到改善（TAPSE从0.59提高到0.68，RV s'从0.41提高到0.58），方差（TAPSE的F统计量从64.9提高到105.3，RV s'从24.7提高到63.9）也得到改善。在所有受试者中，将TAPSE和s'除以RV长度进行指数化处理后，与RVFWS的分类一致性得到改善，这主要是因为纠正了在RV长度较长的受试者中检测异常RVFWS时表现不佳的情况，并且对于RV长度较短的受试者作为正常情况的区分更好。对RV长度进行指数化处理提高了TAPSE（0.80对0.87，P = 0.03）和RV s'（0.65对0.77，P = 0.002）检测异常RVFWS的C统计量。
将TAPSE和RV s'除以RV长度进行指数化处理可提高这些变形测量值与RVFWS的一致性，以及它们根据RVFWS对RV功能障碍患者进行分类的能力。将TAPSE和RV s'除以长度进行指数化处理对于解释矛盾信息特别有效，例如RV长度较短的正常患者中TAPSE和s'较低，以及RV长度增加但TAPSE和s'值正常但有其他RV功能障碍证据的患者。
