二维及实时三维超声心动图评价正常儿童右心室收缩功能与体格发育的相关性研究

Correlation of the right ventricular systolic function indexes evaluated by two- and three-dimensional

目的探讨二维（2DE）与实时三维超声心动图（RT-3DE）评价正常儿童右室整体收缩功能指标的相关性，及其与体格发育的相关性。方法192例正常儿童于心尖四腔观获取2DE右室收缩功能指标：三尖瓣环侧壁收缩期位移距离（TAPSE），三尖瓣环侧壁收缩期峰值运动速度（TRV），右室心尖四腔观面积收缩率（RVa）；于心尖偏胸骨旁四腔心采集RT-3DE右室全容积声像图，应用TomTecRV-Function软件分析获得右室射血分数（RVEF）；对2DE与RT-3DE右室收缩功能指标进行相关性分析，并对各右室收缩功能指标与年龄、身高、体质量、体表面积、心动周期进行相关性回归分析；将192例正常儿童按年龄分为工～V组，对五个年龄组2DE和RT-3DE右室收缩功能指标进行比较。结果RT-3DE获得的RVEF与2DE右室收缩功能指标均无相关性（P〉0．05）；TAPSE、TRV与年龄、体格等指标具有正相关性（P=0．000），RVa与上述指标均无相关性（P〉0．05），RVEF除与心动周期具有较微弱的正相关性（r=0．18，P=0．014）外，与其他各指标均无相关性（P〉0．05）。逐步回归分析表明引起TAPSE、TRV变化的惟-显著性因子分别为身高（R2=0．508，P=0．000）和体表面积（R2=0．130，P=0．000）。RVEF和RVa在5个年龄组中保持恒定（P〉0．05），而TAPSE、TRV在部分组间比较差异有统计学意义（P〈0．05）。结论RT-3DE获得的RVEF不随年龄及体格的发育而变化，受心率影响小，是评价不同年龄和体格人群右室收缩功能的较稳定指标。

Objective To evaluate the right ventricular global systolic function by real-time three dimensional echocardiography （RT-3DE） and two dimensional echocardiography （2DE） in normal children, and investigate their correlation with age,height, weight, body surface area （BSA） and cardiac cycle time. Methods In 192 normal children,2DE right ventricular systolic function indexes were obtained at the apical four chamber view, including： tricuspid annular lateral wall peak systolic excursion （TAPSE）, tricuspid annular peak systolic velocity （TRV） and right ventricular systolic area shortening （RVa）. Full volume imaging of right ventricle was obtained at the parasternal four-chamber view near the apex by RT-3DE. The right ventricular ejection fraction （RVEF） was analyzed by TomTec RV-Function. The correlation analysis was performed between RT-3DE and 2DE indexes. The correlation and regression analysis on RT-3DE and 2DE indexes with above physical development indexes were also studied. At the same time 192 normal children were divided into five groups by age. 2DE and RT-3DE indexes were compared with each other among five age groups. Results RVEF had no statistical correlation with all 2DE indexes （ P〉0.05）. The correlation analysis on RT-3DE and 2DE indexes with physical development indexes demonstrated that TAPSE,TRV had strong positive correlation with the above indexes （ P = 0. 000）, while RVa had no statistical correlation with the above indexes （ P 〉0.05）. RVEF had weak positive correlation with cardiaccycle time （ r = 0. 180, P = 0. 014） ,but it had no statistical correlation with the other indexes （ P ~〉0.05）. Stepwise regression analysis showed that the significant factor for TAPSE and TRV was height （R2 = 0.508, P = 0.000）and BSA（R2 = 0.130, P = 0.000）separately. In five age groups RVEF and RVa remained constant （ P〉0. （15）. However for TAPSE and TRV significant difference were found in part of comparisons between groups（ P 〈0.05）. Conclusions Although RVEF assessed by RT-3DE was slightly influenced by heart rate,it was independent of age,height,weight,BSA. It was a stable index for evaluating right ventricular systolic function among different age and physical development population.