实时三维超声心动图评价肺动脉高压患者右室整体和局部功能的初步研究

Analysis of right ventricular function in patients with pulmonary hypertension using volume-time curves by real-time three-dimensinal echocardiography

目的:探讨实时三维超声心动图评价肺动脉高压患者右室整体和局部收缩及舒张功能改变的应用价值。方法:正常组30例,肺动脉高压组患者35例,行实时三维超声心动图全容积显像方式采集图像数据,并导入TomTec工作站,应用4DRV-function软件行图像后处理,构建右室三维模型,形成右室整体和局部容积-时间曲线。比较两组研究对象实时三维超声心动图参数[右室舒张末容积(EDV)、收缩末容积(ESV)、右室射血分数(RV-EF),右室峰值排空率(RV-PERN)、右室峰值充盈率(RV-PFRN)]之间差异。结果:肺动脉高压组整体和局部EDV、ESV增大,RV-EF、RV-PERN、RV-PFRN减小,差异均有统计学意义(P<0.001)。结论:肺动脉高压患者的右室整体收缩及舒张功能减低,实时三维超声心动图可以准确评价肺动脉高压患者右心功能改变,为临床评价右心功能提供了一种的新手段。

Objective：To evaluate the changes of right ventricular function of patients with pulmonary hypertension using right ventricular volume-time curves by real-time three-dimensional echocardiography （RT-3DE）.Method：Thirty controls and 35 patients with pulmonary hypertension were studied.And all the three-dimensional echocardiographic datasets were acquired by Philips iE33 medical system.Then series of RV parameters,namely end diastolic volume （EDV）,end systolic volume （ESV）,RV ejection fraction （RV-EF）,were offline measured by TomTec 4D RV-Analysis software which can also provide the right ventricular volume-time curves （RV-VTC）.To adjust the intersubject differences in heart rates and EDVs,the time sequence and chamber volumes were normalized separately.EDV,ESV,RV-EF,RV normalized peak filling rate （RV-PFRN）,and RV normalized peak ejection rate （RV-PERN） from RT-3DE were investigated in two groups.Result：①Global volume-time curves of RV appeared ＇U-shaped＇.Campared to normal groups,valleys of the curve in patients with pulmonary hypertension were dispersed; ②Compared to normal control group,the value of EDV and ESV were significantly larger （all P0.001）; RV-EF,RV-PFRN,RV-PERN were reduced significantly （all P0.001）; ③The RV-EF determined by RT-3DE correlated closely with RV-PERN.Conclusion：RT-3DE combined with semi-automatic border detection method could conveniently,accurately measure RV volume and RV-EF without geometric assumption.RV-VTC could be a useful parameter to evaluate RV dysfunction.