Validation of real-time three-dimensional echocardiography for quantifying left and right ventricular volumes: an experimental study

Background Assessment of the left ventricular (LV) and the right ventricular (RV) volumes and their functions is important for prognostic prediction and clinical decision making. We compared the accuracy for quantifying the LV and the RV volumes in vitro between conventional two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT3DE). Methods The volumes of 37 rubber-models (10 regularly shaped to simulate normal LV, 7 shaped to simulate LV with symmetric aneurysm, 8 shaped to simulate LV with asymmetric aneurysm, and 12 irregularly shaped to simulate normal RV) and 10 excised canine hearts were measured by RT3DE and 2DE. On RT3DE “full volume” imaging, the inner-surfaces of the rubber-models and canine LV and RV were outlined and the volumes were measured using 2-, 4-, 8- and 16-plane methods with the RT3DE analysis software. On 2DE imaging, the volumes were measured by the Simpson method. The LV and RV volumes measured by drained water were served as reference values, with which we compared RT3DE and 2DE data.Results In rubber models mimicking normal LV and LV with symmetric aneurysms, RT3DE results were strongly correlated with reference values (r=0.795-0.998) and there was a good correlation between 2DE estimates and reference values (r=0.715-0.729). There were no significant differences between RT3DE estimates, 2DE results and reference values (P>0.05). In rubber models mimicking the RV and LV with asymmetric aneurysm, RT3DE strongly correlated with reference values (r=0.765-0.988), but 2DE weakly correlated with reference values (r=0.518-0.592). There were no differences between RT3DE and reference values (P>0.05), but a significant difference between 2DE and reference values occurred (P<0.05). For excised canine hearts, there was a strong correlation between RT3DE and reference values (r=0.728-0.914), while 2DE showed a less obvious correlation (r=0.502-0.615). Again, there were no significant differences between RT3DE and reference values (P>0.05), but there was a significant difference between 2DE and reference values (P<0.05).Conclusions RT3DE can accurately quantify LV and RV volumes and provides a new tool to evaluate LV and RV function. For LV and RV measurements by RT3DE, 8-plane strategy is the optimum choice for accuracy and convenience.     

REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY FOR QUANTIFYING LEFT VENTRICULAR MASS

LEFTventricularmass(LVM)isanimportantandindependentdeterminantparameterintheevaluationofpatientswithcardiovasculardisease.Echocardi-ographyisthemostwidelyusedclinicalmethodforassessm-entofLVM.1 However,conventionaltwo-dimensionalecho-cardiography(2DE)islimitedbyassumptionsaboutventric-ularshape.2,3 Recentlyreal-timethree-dimensionalechocardi-graphy(RT3DE)isanewbreakthroughinthefieldofultr-sonictechnique,whichcanallowquantitativemeasurementsobemadewithoutrelianceongeometricassumption.4-6 …     

三维超声心动图结合声学造影测量正常人右室心搏量的研究

目的 评价三维超声心动图结合右心声学造影技术测量正常人右室心搏量的准确性.方法 应用三维超声诊断仪对15例健康自愿者分别采集无造影、经静脉右心造影的心尖长轴全容积三维数据库,脱机后应用容积分析软件进行后处理分析,运用8个平面勾画右室内膜面,测量右室舒张末期容积(RVEDV)与收缩末期容积(RVESV),计算右室每搏量(RVSV),同时用多普勒频谱法计算左室每搏量(LVSV),进行左右每搏量对照分析.结果 运用右心声学造影后,右室内膜面显示更为清晰,可重复性增加.RT3DE有造影测得的RVSV与多普勒频谱法测得的LVSV之间具有很好的相关性(r＝0.894),而无造影下的相关性要低于有造影(r＝0.758).LVSV与三维超声心动图有造影的RVSV比较差异无显著性(P＞0.05);与三维超声心动图无造影的RVSV之间差异有显著性(P＜0.05).结论 右心声学造影技术可以提高三维超声心动图测量正常人右室心搏量的准确性.     

Evaluation of Right Ventricular Volume and Systolic Function by Realtime Three-dimensional Echocardiography

Increasing evidence from clinical investigationis emphasizing the importance of evaluating rightventricular (RV) function[1—4]. Whereas, becauseof the complex shape, evaluation of RV functionby conventional 2 D echocardiography has beenconsidered difficult. The development of real timethree dimensional echocardiography ( RT3DE )opens up the possibility of assessing RV function.This high speed, volumetric ultrasound scanningsystem could display the cardiac spat…     

The accuracy and optimal slice thickness of multislice helical computed tomography for right and left ventricular volume measurement

Background Multislice helical computed tomography (MSCT) has been used to depict coronary anatomy noninvasively, and proved useful for evaluating ventricular function. The aim of our study was to assess the accuracy of ventricular volume as measured by MSCT.Methods Fourteen human left ventricular (LV) and 15 right ventricular (RV) casts were scanned by MSCT. A series of LV and RV short-axis images were reconstructed later with slice thickness of 2.0 mm, 3.5 mm, 5.0 mm, 7.0 mm, and 10.0 mm. Ventricular volume was calculated by the multislice tomographic Simpson’s method. True LV and RV cast volumes were determined by water displacement. Results Both calculated LV and RV volumes correlated highly with the corresponding true volumes (all r>0.95, P<0.01). But with slice thickness from 2.0 mm to 10.0 mm, MSCT scanning overestimated the corresponding true volume by (3.21±5.95) ml to (12.58±8.56) ml for LV and (10.22±8.45) ml to (23.91±12.24) ml for RV (all P<0.01). There was a very high correlation between the overestimation and the selected slice thickness for both LV and RV volume measurements (r=0.998 and 0.996, P<0.01, respectively). However, when slice thickness was reduced to 5.0 mm, the overestimation for both LV and RV volume measurements became nonsignificant for slice thickness from 2.0 mm to 5.0 mm. Conclusions Both LV and RV volumes can be accurately estimated by MSCT. Thinner slice has more accurate calculated volume. However, 5.0 mm slice thickness is thin enough for an accurate measurement of LV or RV volume.     

三维超声心动图测量心肌梗塞后左室容量的实验研究

目的　探讨三维超声心动图 ( 3DE)测量急性心肌梗塞 (AMI)后左心室舒张末期容量 (LVEDV)的准确性及其临床意义。方法　应用 3DE分别测量 13只兔AMI后的LVEDV ,同时应用离体注水法测量左心室 (LV)容量。结果　 3DE所测LVEDV为 2 .30± 0 .11ml,离体注水法所测LV容量为 2 .2 4± 0 .0 9ml,两者之间高度相关 (r=0 .92 ,P <0 .0 1) ;两均数间差异无显著性 (MD =0 .0 6ml,P >0 .0 5 )。结论　 3DE是一种测量左心室容量的检查方法 ,尤其是在节段室壁运动异常引起左心室变形的情况下更为明显。     

Real-time three-dimensional echocardiographic assessment of left ventricular remodeling index in patients with hypertensive heart disease and coronary artery disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.     

实时三维超声心动图对急性肺栓塞患者右心功能的评估

目的：探讨实时三维超声心动图（RT-3DE）评价急性肺栓塞（APE）患者右心功能的价值。方法：使用RT-3DE采集30例APE患者和30例健康志愿者心脏全容积图像导入TomTec工作站,应用4D RV-Function软件分析,生成右室容积-时间变化曲线（RV-VTC）。比较两组对象RT-3DE参数右室舒张末期容积（EDV）、收缩末期容积（ESV）,射血分数（EF）,峰值排空率（PER）和峰值充盈率（PFR）之间的差异。结果：与对照组相比,APE患者右室整体EDV、ESV增大,EF、PER、PFR减小,差异均有统计学意义（t=2.490、2.172、2.897、2.894及3.042,均P〈0.05）。结论：APE患者的右室整体收缩及舒张功能减低,RT-3DE可以准确评价APE患者右心功能改变。     

实时三维超声心动图评价房间隔缺损不同手术方式的右室收缩功能变化

目的 应用实时三维超声心动图(real-time three dimensional echocardiography, RT-3DE)研究房间隔缺损(atrial septal defect, ASD)不同手术方式右室收缩功能的变化.方法 ASD患者按照不同手术方式分为外科手术组和封堵组;常规二维超声心动图检查后,使用RT-3DE采集患者的右室全容积数据库,分析右室舒张末容量(right ventricular end diastolic volume, RVEDV)和收缩末容量(right ventricular end systolic volume, RVESV)、计算右室射血分数(right ventricular ejection fraction, RVEF).比较术前、术后7 d、术后3个月的RVEDV、RVESV、RVEF值变化.结果 术后7 d,封堵组右室RVEDV、RVESV均较术前明显减小(P＜0.05),RVEF值与术前无显著差异;外科手术组右室RVEDV较术前明显减小(P＜0.05),但RVESV较术前无统计学差异,并且EF值较术前减低(P＜0.05).术后3个月两组的RVEF值均较术前明显增高(P＜0.05).结论 RT-3DE能简便、准确地确定右室容积并计算右室收缩功能;ASD患者外科手术组术后早期右室收缩功能较术前减低, 术后3个月恢复到正常水平,封堵组术后初期EF值即达正常水平.     

Preliminary Clinical Study of Real-time Three-dimensional Echocardiographic Volume-time Curve in Evaluating Left Ventricular Diastolic Function

The volume-time curve change in patients with normal left ventricular （LV） diastolic function and diastolic dysfunction was evaluated by real-time three-dimensional echocardiography （RT3DE）. LV diastolic dysfunction was defined by E＇〈A＇ in pulse-wave tissue Doppler for inter-ventricular septal （IVS） of mitral annulus. In 24 patients with LV diastolic dysfunction, including 12 patients with delayed relaxation （delayed relaxation group） and 12 patients with pseudo-normal function （pseudo-normal group） and 24 normal volunteers （control group）, data of full-volume image were acquired by real-time three-dimensional echocardiography and subjected to volume-time curve analysis. EDV （end-diastolic volume）, ESV （end-systolic volume）, LVEF （left ventricular ejection fraction）, PER （peak ejection rate）, PFR （peak filling rate） from RT3DE were examined in the three groups. Compared to the control group, PFR （diastolic filling index of RT3DE） was significantly reduced in the delayed relaxation group and pseudo-normal group （P〈0.05）. There were no significant differences in EDV, ESV, LVEE PER （P〉0.05）. It is concluded that PFR, as a diastolic filling index of RT3DE, can reflect the early diastolic function and serve as a new non-invasive, quick and accurate tool for clinical assessment of LV diastolic function.     

实时三维超声心动图评估左室不同舒张功能状态的左心房容积与功能

目的 探讨实时三维超声心动图（RT-3DE）评估左心室不同舒张功能状态的左房容积与功能的价值。方法 108名受检者根据左心室不同舒张功能状态分成正常组、顺应性降低组、假性正常化组及限制性充盈障碍组。RT-3DE测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）、左房收缩前容积（LAVpreA）,并对参数用体表面积校正,得出LAVmax指数、LAVmin指数、LAVpreA指数,计算左房整体射血分数（LAEF）、左房被动射血分数（LApassive）、左房主动射血分数（LAactive）。并将RT-3DE所测左房功能相关参数与应用脉冲多普勒及组织多普勒测量反映左室舒张功能相关参数作对比。结果 二尖瓣口舒张期前向峰值血流速度E与二尖瓣前瓣环组织多普勒E,比值（E/ E,）及二尖瓣口舒张期前向峰值血流速度E与二尖瓣口M型彩色多普勒峰值血流速度Vp（E/Vp）随着舒张功能障碍加重而增加,而E峰减速时间（Dct）随着舒张功能障碍加重而降低（P<0.05）; LAVmax 指数、LAVmin指数随舒张功能降低而增加,LAEF随舒张功能降低而降低（P<0.05）; E/ E,、E/Vp及Dct与LAEF相关性相关性最佳,r分别为-0.84,-0.81,0.74（P<0.05）; LAVmax指数≥34ml/m2、LAEF≥30%诊断左室充盈压增高（即E/ E, >15.0）,其敏感度和特异度分别为86.0%,66.7%及86.7%,80.6%。结论 RT-3DE为评价左房容积与功能提供了新方法,测得左房功能参数能准确反映左室舒张功能受损程度。     

QUANTITATIVE ASSESSMENT OF MYOCARDIAL PERFUSION DEFECTS WITH REAL-TIME THREE-DIMENSIONAL MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

QUANTITATIVE assessment of perfusion defectswith myocardial contrast echocardiography(MCE)could be a promising tool in the evalu-ation of patients with coronary artery disease·With the im-provement of microbubble contrast media and correspond-ing develop…     

实时三维超声心动图的局部容积-时间曲线评价冠心病患者的局部心肌功能

目的 应用实时三维超声心动图(RT-3DE)左室局部容积-时间曲线(LVRV-TC)技术分析冠心病(CAD)患者的左室局部容积变化,评价局部心肌功能. 方法 CAD组33例,对照组29例.RT-3DE全容积成像显示LVRV-TC图形,测量收缩与舒张末期最大和最小的左室局部容积,分析心室节段的区域. 结果 与对照组比较,CAD组的收缩与舒张期左室局部最大容积(RVmax)与局部最小容积(RVmin)增加(P＜0.001;P＜0.05),左室局部射血分数(REF)降低(P＜0.001). 结论 RT-3DE的LVRV-TC测量左室容积变化有助于评价CAD患者的左室局部心肌功能.     

64排螺旋CT评价右心室功能的准确性研究

目的 评价64排螺旋CT(64-MDCT)能否作为一种新的方法 准确测量右室功能,并以磁共振(MRI)作参照标准衡量其准确性.方法 32例志愿者被连续纳入行64-MDCT和MRI扫描,获得右室心功能参数包括舒张末期容积(RV-EDV),收缩末期容积(RV-ESV),每搏量(RV-SV)和射血分数(RV-EF).以MRI结果 作参照标准,比较评价两种检查方法 的一致性和准确性.结果 两种方法 的各心室容积参数和射血分数的差异无统计学意义(P为0.29～0.66).一致性检验和相关分析表明RV-EDV[(0.6±4.9)mL;r=0.98]、RV-ESV[(-0.6±3.4)mL;r=0.97],RV-SV[(0.9±5.6)mL;r=0.93]和RV-EF[(1.0±3.9)mL;r=0.88]在MRI和64-MDCT之间的一致性和相关性好.结论 64-MDCT可作为一种新的手段准确评价右室功能.     

实时三维超声心动图左室射血分数-时间曲线评价正常人左室收缩功能的初步研究

目的　应用实时三维超声心动图 (real timethreedimensionalechocardiography ,RT3DE) ,技术和相应软件、工作站绘制正常人左室节段射曲分数 -时间曲线 (regionalEF timecurves ,rEF TC) ,探讨这一新技术以rEF TC方式评价左室节段收缩功能的可行性。方法　使用实时三维超声全容积采集 3 7例健康志愿者心尖四腔观全容积数据库 ,以三维数据测量分析软件和计算统计软件计算左室局部收缩功能指标 ,绘制rEF TC ,获得rEF正常值范围 ,进行曲线模型拟合 ,比较各部分间差异性。所有研究对象均获得满意二维、三维图像、全容积三维数据以及动态rEF TC。 16段rEF间差异明显 ;心尖部收缩功能最强 ,基底部最低 (P =0 .0 0 0 )。曲线估计获得模型方程Y =bo b1t b2 t2 b3 t3 ,回归系数R2 =0 .914～ 0 .996,平均R2 ( 0 963± 0 0 85 )。结论　正常人左室基底部至心尖部收缩功能有增强趋势。RT3DE以rEF TC方法评价左室局部收缩功能具有可行性和广阔应用前景。     

三维超声心动图左室容积值与左室造影参数的相关性分析

应用国内三维超声心动图(3DE)计算机软件系统,测定20例正常人及40例心血管病患者的左室容积值,观察各组心血管病左室长轴,短轴内壁周长及周长缩短率的变化,并就10例患者进行了3DE与左室造影心功能参数的相关性分析。结果表明,正常组与各心血管病组左室容积值差异显著;差异的内在规律集中在心室短轴缩短率的变化上;3DE测定的左室容积值与左室造影所测参数比较,相关性密切。     

二维和实时三维超声心动图量化分析左心室容积和功能的相关性

目的对比分析二维(2DE)、实时三维超声心动图(RT-3DE)量化分析左心室容积和功能的差异,探讨二者之间的相关性,从而探讨RT-3DE在量化分析左心室容积和功能方面的可行性及可靠性。方法入选研究对象共33例,其中健康志愿者10例,慢性心力衰竭患者23例,同时为其行2DE(面积长度法)及RT-3DE检查,获得左心室舒张末期容积(LVEDV)、左心室收缩期容积(LVESV)、每搏量(SV)及左心室射血分数(LVEF)。结果33例研究对象中32例(96.97%)获得了具有清晰内膜边界的左心室2DE和RT-3DE图像;RT-3DE所获得的LVEDV、LVESV、SV、LVEF值明显低于2DE获得的值(均P<0.05);2种方法所获得的值相关性良好(均P<0.05)。结论RT-3DE是一种定量评价左心室功能的新技术,有一定的可靠性和可行性。     

Real-time three-dimensional myocardial contrast echocardiography in assessment of myocardial perfusion defects

Background Both real-time three-dimensional echocardiography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects. Methods Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n=6) or distal branch of the left circumflex artery (LCX, n=7) under general anaesthesia. Three to four ml of a perfluoropropane (C3F8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and right coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals’ hearts were used as controls. Results Left ventricular (LV) mass determined by RT3DE ranged 36.7-68.9 g ［mean, （54.6±9.6） g］ before coronary artery ligation, and correlated highly (r=0.99) with in vitro measurement of LV mass ［range, 38.9-71.1 g; mean, (55.6±9.3) g］. There was no significant difference between RT3DE and in vitro measurements of LV mass ［range, 36.7-68.9 g; mean, （51.3±12.5） g. Or range, 38.9-71.1 g; mean, （53.7±12.3） g, respectively］ and under-perfused mass ［range, 0-21.4 g; mean, （12.0±6.9） g. Or range, 0-19.8 g; mean, （10.8±6.3） g, respectively］ after the LAD ligation (P&gt;0.05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass ［range, 50.1-65.4 g; mean, （57.5±5.9） g. Or range, 51.5-65.8 g; mean, （57.3±6.4） g, respectively］ and under-perfused mass ［range, 0-25.6 g; mean, （13.3±9.6） g. Or range, 0-22.7 g; mean, （12.8±8.1） g, respectively］ after the LCX ligation (P&gt;0.05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35.9-68.6 g ［mean, （54.8±10.0） g］ and there was no significant difference between RT3DE and in vitro measurements of LV mass and under-perfused mass (P&gt;0.05, r=0.99). Further, the under-perfused mass derived from RT3DE ［range, 0-25.6 g; mean, （12.7±8.2） g］ correlated strongly with the in vitro measurements ［range, 0-22.7 g; mean, （11.9±7.2） g］ (r=0.96). Conclusion RT3DE with MCE is a rapid and accurate method for estimating LV myocardial mass and quantifying perfusion defects.     

应用时间空间相关成像技术与超声心动图评价胎儿左心功能的对比研究

目的：探讨时间空间相关成像技术（STIC）在胎儿左室容积和左室收缩功能测量中的应用价值。方法：对48例孕龄22周～32周正常胎儿心脏同时应用（STIC）、二维超声心动图（2DE）双平面Simpson法对其左室舒张末期容积（LVEDV）、收缩末期容积（LVESV）、每搏输出量（LVSV）及射血分数（LVEF）等容积及功能指标进行测定,分析其测量结果。结果：应用STIC技术测得LVEDV为（1．45±0．65）mL、LVESV为（0．48±0．26）mL、LVSV为（0．98±0．44）mL、LVEF为（67．38±8．46）％。应用2DE双平面Simpson法测得LVEDV为（1．33±0．60）mL、LVESV为（0．43±0．26）mL、LVSV为（0．90±0．40）mL、LVEF为（69．07±10．14）％。STIC法与2DE Simpson法所测LVEDV、LVESV间差异无显著性（P〉0．05）,并均有显著的相关性（r=0．976、0．915、P〈0．001）。STIC法与2DE Simpson法所测LVSV、LVEF值差异无显著性（P〉0．05）,相关性较好（r=0．709,0．940,P〈0．001）。结论：时间空间相关成像技术（STIC）,可准确测量胎儿左心室容积,评价胎儿左心收缩功能,有重要的应用价值。     

探讨单次屏气压缩感知实时电影成像在磁共振心室功能及应变评估中的可行性

  目的  探讨磁共振单次屏气压缩感知实时电影成像（single-breath-hold compressed sensing real-time cine imaging, CS-cine）在心室功能及应变评估中的可行性。  方法  前瞻性连续纳入70例受检者,所有患者均行心脏磁共振标准稳态自由进动电影成像（standard steady-state free precession cine imaging, sta-cine）和CS-cine。电影序列扫描方位:从心底到心尖的连续短轴位及左室两腔、三腔、四腔长轴位,同一受检者的两组电影图像扫描范围、层数、层厚、层间距等一致。对所有电影图像进行主观图像质量评价,并通过后处理软件分析得出左、右常规心室功能参数和左室应变参数。比较两组电影图像质量、常规心室功能参数及左室应变参数之间的差异。通过计算组内相关系数（ICC）验证CS-cine心室定量参数的重复性,采用Bland-Altman分析两组电影间心室定量参数的一致性。  结果  sta-cine组、CS-cine组电影的中位采集时间分别为272 s和21 s。sta-cine组、CS-cine组电影图像质量评分中位数分别为4分和2分,差异有统计学意义（P<0.001）。两组电影间常规心室功能参数比较:CS-cine所获得的射血分数（ejection fraction, EF）、舒张末期容积（end-diastolic volume, EDV）、搏出量（stroke volume, SV）均显著降低（P<0.001）,而左、右室收缩末期容积（end-systolic volume, ESV）及左室心肌质量（left ventricular mass, LVmass）差异无统计学意义（P>0.05）。两组电影间应变参数比较:左室中部径向应变峰值（peak radial strain, PRS）、周向应变峰值（peak circumferential strain, PCS）及纵向应变峰值（peak longitudinal strain, PLS）差异均有统计学意义（P<0.001）。CS-cine各功能定量参数都具有较好的重复性（ICC=0.88～0.99）,Bland-Altman分析结果显示各参数测量中,右室容积功能及左室PCS、PLS测量有95%以上在一致性范围内,其余参数测量结果均有91%以上在一致性界值内,可认为两组电影测量结果一致性较好。  结论  CS-cine能够快速获取图像进行心功能定量分析,其分析所得常规心室功能参数及左室整体应变参数有较好的重复性。