Multiplane two-dimensional strain echocardiography for segmental analysis of right ventricular mechanics

Introduction

Recent studies showed the prognostic value of strain measurements of the free right ventricular (RV) wall. The aim of this study was to evaluate the feasibility and the diagnostic value of the assessment of longitudinal mechanics of all segments of the RV by multiplane, two-dimensional transthoracic (2D) strain echocardiography.

Methods

A triplane apical visualization of the RV was attempted in each individual. RV systolic function was assessed with RV 2D strain, RV automated systolic index, real-time 3D echocardiography and RV parameters according to current guidelines.

Results

The study population (n = 118) consisted of 81 consecutive patients with overt right ventricular systolic dysfunction due to different etiologies, 13 patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and 24 healthy controls. Triplane assessment of the RV was possible in all examinations. 2D strain of 18 segments could be obtained in 75 %, 9 segments of the RV free wall in 84 % and 3 segments in four-chamber view in 96 % of the examinations. Contrary to established RV parameters, RV 2D strain detected impaired RV function in all patient groups compared to the control group. In regard to global RV function, RV 2D strain by multiplane assessment was not superior to a monoplane approach. However, segmental strain analysis was able to define the presence of impaired RV function in ARVC patients which otherwise would have been missed by current standard parameters.

Conclusion

Regional RV mechanics were reliably assessed by RV 2D strain in a multiplane apical chamber view mode.     

Estimation of right ventricular mass by two-dimensional echocardiography.

BACKGROUND: This report describes two original echocardiographic approaches to measure right ventricular (RV) mass (RVM). METHODS: In the bullet formula (5/24 pi D1 D2 L), where D1 and D2 are short axes and L the log axis, the RVM is obtained by subtracting the cavity volume from the RV total volume and subsequently multiplying the difference by myocardium density. The second method uses 3 endocardium segments measured at: (1) short axis plane of the aortic valve and left atrium (b1); (2) short axis plane at the midpoint between the tricuspid valve annulus and the apex (b2); and (3) 4-chamber view (h). Those segment lengths are applying in the formula A = [(b1 + b2)/2] x h. The result is multiplied by the wall thickness and by myocardium density. RESULTS: Both formulas were primarily tested in 30 mongrel dogs and have shown good correlation with the true mass ( r = 0.869 with the segments formula and r = 0.819 with the bullet formula). The same method was used in 20 human patients before heart transplant with similar results ( r = 0.810 with the segments formula and r = 0.836 with the bullet formula). CONCLUSIONS: The RVM can be satisfactorily estimated by 2-dimensional echocardiography. The linear regression between the calculated mass (using the smoothest and thinner myocardium thickness) and the actual mass may provide the correction factor for the RVM calculation. Two echocardiographic methods were used to measure right ventricular mass. One of them used a bullet formula variant (5/24 pi D1 D2 L). The second method used 3 endocardium segments measured in 3 2-dimensional echocardiographic planes (short axis of aortic valve and left ventricle, and 4-chamber view), and applied in the formula A = [(b1 + b2)/2] x h. Both formulas have shown good correlation with the true mass in 30 mongrel dogs ( r = 0.869 with the segments formula and r = 0.819 with the bullet formula) and in 20 human patients before heart transplant ( r = 0.810 and r = 0.836, respectively).     

应用心脏磁共振Tissue tracking探讨右室长轴心肌应力与年龄性别的关系

目的应用心脏磁共振Tissue tracking评估健康中国人右心室心肌长轴应力参数范围,以及分析其与年龄性别的关系。材料与方法以在中国医科大学附属第一医院接受心脏磁共振扫描的100名健康志愿者为研究对象,年龄20～70岁,平均年龄(45.4±15.3)岁,10岁一个年龄段分为5组,每组20人,应用德国SiemensVerio3.0TMR自由进动稳态序列采集右心室电影序列图像,实施组织追踪技术获取右室长轴应力及应力率,并对结果进行统计学分析。纳入标准:无先天性或者获得性心脏疾病、无高血压、糖尿病、血脂异常、肥胖以及全身性疾病,左室收缩和舒张功能正常。结果整体长轴应力峰值(global longitudinal strain,GLS)为(-24.2±4.6)%,女性与男性比较差异无统计学意义[(-24.7±5.3)%vs (-23.5±3.6)%,P>0.05];整体长轴应力峰值与年龄无相关性(P>0.05),长轴收缩期应力率(GLS S')为-1.6±0.6(1/s),女性与男性比较差异无统计学意义[-1.7±0.6(1/s) vs-1.5±0.7(1/s),P>0.05)];长轴舒张期应力率(GLS D')为1.3±0.4(1/s),女性与男性比较差异无统计学意义[1.3±0.3(1/s) vs 1.4±0.4(1/s),P>0.05];长轴收缩期应力率(GLSD')与年龄无相关性(P>0.05);长轴舒张期应力率(GLS D')与年龄亦无相关性(P>0.05)。结论应用心脏磁共振Tissue tracking可以有效且可重复性获取右心室心肌应力参数,健康中国人右心室心肌长轴应力及应力率与年龄性别不存在显著相关性,因此右心室长轴心肌应力及应力率正常参数可以为临床右心室心脏疾病早期诊断提供参考标准。     

Determination of right ventricular volume by two-dimensional echocardiography with a crescentic model

Right ventricular volume in 14 fixed hearts from dogs was determined by echocardiography with an algorithm that takes into consideration the crescentic shape of the right ventricular (RV) cross-sectional area. To validate this model the volumes obtained by echocardiography were compared with volumes obtained by water displacement of silicone casts of the same 14 hearts. A strong linear correlation was demonstrated between the echocardiographic volumes and the volumes obtained by water displacement of RV casts (r = 0.96). The results also showed that the echocardiographic volume determination underestimated the RV volume obtained from cast with an almost constant ratio averaging 0.755 as a result of the exclusion of the RV outflow tract volume from the echocardiographic model. We conclude that a crescentic model allows accurate echocardiographic determination of RV volume.     

二维应变超声成像技术评价心力衰竭患者左心功能的初步研究

目的 探讨二维应变超声心动图评价心力衰竭患者左心室心肌收缩及舒张功能的价值.方法 选取心力衰竭患者21例(心力衰竭组),心功能正常,排除冠心病、心肌病、心律失常等其他心脏疾病的患者16例(对照组).对两组患者进行常规超声心动图测量,分别采集心尖长轴四腔切面、心尖长轴三腔切面、心尖长轴二腔切面,二尖瓣水平短轴切面、乳头肌水平短轴切面及心尖水平短轴切面的二维灰阶动态图.应用2DS软件测量并计算心力衰竭组及对照组左心室长轴整体收缩期最大峰值应变(GLS)、左心室轴向整体收缩期最大峰值应变(GCS)、左心室整体扭转度(ROT)、左心室整体扭转率(ROTR)、心脏整体收缩期应变率(GSRs)、舒张早期应变率(GSRe)、舒张晚期应变率(GSRa)、GSRe/GSRa及达舒张早期峰值应变率(SRe)时间(T-SRe).将心力衰竭组与对照组左心室常规及二维应变指标测值进行比较,采用成组计量资料的t检验,分析应变参数与左心室射血分数(LVEF)的相关性.结果 心力衰竭组的常规超声心动图指标LAD、LVDd、LVDs、LVEF、LVFS、E、A、EDT分别为(46.38±6.42)mm、(68.67±8.84)mm、(56.24±8.41)mm、(36.81±4.56)%、(18.47±2.35)%、(0.06±0.06)m/s、(0.07±0.04)m/s、(102.29±32.13)ms;对照组的分别为(30.50±2.78)mm、(45.06±2.57)mm、(29.06±2.21)mm、(65.10±2.66)%、(35.56±1.92)%、(0.76±0.07)m/s、(0.57±0.07)m/s、(178.69±38.16)ms,两组比较差异有统计学意义(t=-9.230、-10.324、12.557、-22.064、-23.611、-42.996、-28.284、-6.608,P均＜0.05);心力衰竭组患者常规超声心动图相关二维应变指标GLS、GCS、ROT、ROTR、GSRs、GSRe、GSRa、T-SRe分别为(-7.87±3.79)%、(-7.86±2.77)%、(4.80±2.19)deg、(37.48±11.12)deg/s、(-0.42±0.26)s-1、(0.47±0.29)s-1、(0.30±0.20)s-1、(387.75±80.64)ms,对照组的分别为(-20.52±2.67)%、(-24.63±5.32)%、(13.08±5.82)deg、(109.13±24.31)deg/s、(-1.36±0.23)s-1、(1.53±0.29)s-1、(0.80±0.25)s-1、(321.33±32.63)ms,两组比较差异均有统计学意义(t=11.348、12.431、-6.008、-11.997、11.563、-10.968、-6.732、3.099,P均＜0.05).GLS、GCS与LVEF之间有显著相关性(r=-0.815、-0.864,P均＜0.05).结论 二维应变超声技术对评价心力衰竭患者的左心室功能有很好的应用价值.     

Normal values of cervical vertebral measurements according to age and sex in CT

Introduction

Atlantodental interval (ADI), basion-dental interval (BDI) and the thickness of prevertebral soft tissue (TOPST) measured in lateral cervical radiographs were reported to be useful indicators and indirect signs of underlying cervical spine injuries. However, cervical computed tomography (MDCT) is the first method of imaging used in all trauma patients and upper normal limits (UNLs) of cervical distances according to age and sex are undetermined. Therefore, we aimed to calculate these metrics.

二维斑点追踪超声心动图对业余马拉松运动员右心室收缩功能的评估

目的应用二维斑点追踪超声心动图评估业余马拉松运动员右心室收缩功能。 方法2019年1月至2020年12月,在杭州地区招募业余马拉松运动员88例,根据参加马拉松运动时限分为短期组（≤6个月）、中长期组（6个月~3年）和长期组（＞3年）;另选取同一时期在杭州师范大学附属医院体检的健康受试者30例为对照组。应用常规超声心动图测量右心室流出道内径（RVOT）、右心室基底段内径（RVD_basal）及中间段内径（RVD_mid）、右心室剑突下切面室壁厚度（RVWT）、三尖瓣环收缩期位移（TAPSE）、三尖瓣环收缩期速度（S′）、右心室心肌做功指数（RIMP）和肺动脉收缩压（SPAP）,应用二维斑点追踪技术获得右心室整体纵向应变（GLS）和游离壁纵向应变（RVLS）。对业余马拉松运动员在完成全程马拉松运动前、运动后1 h和运动后第4天分别行超声心动图检查。对4组受试者的常规超声心动图参数及右心室应变参数进行比较,并分析马拉松运动员运动前GLS、RVLS与SPAP的相关性。 结果短期组TAPSE高于对照组,差异有统计学意义（P＜0.05）;中长期组RVOT、RVD_basal、RVD_mid、RVWT均高于短期组,差异有统计学意义（P均＜0.05）;长期组RVOT、RVD_basal、RVD_mid均高于中长期组,差异有统计学意义（P均＜0.05）;长期组RVWT、RIMP、SPAP高于对照组,差异有统计学意义（P均＜0.01）。短期组RVLS高于对照组,差异有统计学意义（P＜0.05）;长期组GLS低于短期组及对照组,差异有统计学意义（P均＜0.05）。运动后1 h及第4天中长期组GLS、RVLS低于短期组,差异均有统计学意义（Z=2.416、-2.579,Z=2.254、-3.005,P均＜0.05）,长期组GLS、RVLS亦低于短期组,且差异均有统计学意义（Z=-2.858、-2.825,Z=-3.524、-4.073,P均＜0.05）。组内运动前后比较,中长期组、长期组运动后1 h GLS均低于运动前,差异有统计学意义（Z=-1.968、-1.966,P均＜0.05）;短期组、中长期组和长期组运动后1 h RVLS均低于运动前,差异有统计学意义（Z=2.011、-2.258、-2.026,P均＜0.05）。相关性分析表明,运动员组运动前的GLS、RVLS与SPAP存在相关性（r=0.378、0.325,P均＜0.01）。 结论业余马拉松运动员早期右心室游离壁纵向收缩功能增强,随着运动年限增加右心室整体纵向收缩功能减低;全程马拉松运动后右心室游离壁收缩功能短暂下降。     

Evaluation of right atrial function by two-dimensional speckle-tracking echocardiography in patients with right ventricular myocardial infarction

Right ventricular myocardial infarction (RVMI) damages the systolic and diastolic functions of the RV, so the right atrium interacts with the RV with an acutely altered function. The aim of our study was to compare right atrial function as evaluated by 2D speckle-tracking echocardiography (2DSTE) between patients with inferior wall myocardial infarction (INFMI) and patients affected by both inferior myocardial infarction and right ventricular myocardial infarction (INFMI?+?RVMI). Our study recruited 70 consecutive patients with INFMI (43 patients without RVMI and 27 patients with RVMI). Right atrial function was evaluated by 2DSTE. Early diastolic strain, systolic strain rate, absolute value of early diastolic strain rate, expansion index, and diastolic emptying index of the right atrium were reduced in the patients with INFMI?+?RVMI compared to the patients with INFMI. The area under the curve for early diastolic strain for INFMI diagnosis was 0.682 (p value?=?0.011, 95?% CI 0.550–0.815). Right atrial early diastolic longitudinal strain <27.5?% had 59.3?% sensitivity and 79.1?% specificity for the discrimination of INFMI?+?RVMI from INFMI. Our results demonstrated that right atrial reservoir and conduit functions were impaired in the patients with INFMI?+?RVMI compared with the patients with INFMI.     

Accuracy of emergency physician-performed limited echocardiography for right ventricular strain

Background

Pulmonary embolism (PE) is a common emergency department (ED) diagnosis with a wide range in mortality rates. Methods to identify and risk-stratify PE, including measuring right ventricular strain (RVS) by echocardiography (echo), are essential in providing effective and efficient care. A limited echo examination aims to expedite and increase availability of RVS determination through assessment at the bedside by the ED provider.

Objective

The objective is to determine the level of agreement and test characteristics of right ventricular dilation (RVd), as a marker of RVS, on limited echo compared with consultative echo.

Methods

This is a retrospective cohort study of consecutive ED patients undergoing limited echo examinations for chest pain, dyspnea, or hypotension and a subsequent consultative echo within 72 hours. κ values and test characteristics were calculated to determine the level of agreement and accuracy between the limited echo examination and consultative echo for RVd and RVS.

Results

There were 411 focused examinations performed by 69 different providers over a 12-month period (median, 5 examinations per provider). The prevalence of RVS on limited echo examination was 6.2% (n = 25). The κ value for the level of agreement between limited and consultative echo for RVd was 0.44 (95% confidence intervals [CI], 0.27-0.61). The specificity of RVd on limited echo for RVS was 0.98 (95% CI, 0.96-0.99) with 6 false-positive categorizations, whereas the sensitivity was 0.26 (95% CI, 0.16-0.37).

Conclusions

In this retrospective cohort study, limited echo demonstrated moderate agreement with consultative echo for RVd. Right ventricular dilation on limited echo was highly specific for RVS but had low sensitivity.     

二维应变超声心动图评价移植心脏左心室收缩功能

目的应用二维应变超声心动图检测移植心脏左室壁峰值收缩应变,探讨二维应变超声心动图评价移植心脏左室收缩功能的价值。方法9例心脏移植受者共进行41次超声检查;23例正常人作为对照。记录心尖长轴观、心尖两腔观及心尖四腔观的高帧频二维图像,应用二维应变分析软件测量左室壁各节段的峰值收缩应变及心尖各切面观心肌总的峰值收缩应变、左室整体平均峰值收缩应变。结果无排异反应的心脏移植受者与正常人相比,除了4个心尖节段（后壁心尖段、前间隔心尖段、侧壁心尖段、前壁心尖段）外,左室壁各节段峰值收缩应变均显著降低（P〈0.05）;心尖各切面观心肌总的峰值收缩应变及左室整体平均峰值收缩应变均较正常显著降低（P〈0.05）。急性排异反应与无排异反应的心脏移植受者后室间隔及侧壁各节段相比,峰值收缩应变均有下降趋势,但仅后室间隔心尖段峰值收缩应变降低具有统计学意义（P〈0.05）。急性排异反应的心脏移植受者心尖四腔观心肌总的峰值收缩应变较无排异反应的心脏移植受者则显著降低（P〈0.05）。结论二维应变超声心动图可用于快速准确评价移植心脏左室收缩功能,在排异反应诊断方面具有潜在价值。     

二维应变方法对左心室心肌机械运动特性的观察

目的 研究正常人心肌机械运动特性.方法 研究对象为60例正常志愿者,男34例,年龄(42.0±13.0)岁;女26例,年龄(37.0±10.0)岁,应用超声心动图二维斑点成像技术评价左心室纵向、径向和圆周向运动的心肌机械运动参数,包括收缩应变、收缩应变率和舒张应变率及其达峰时间.结果左心室收缩应变纵向运动和圆周向表现出自基底部至心尖部收缩应变的绝对值递增,纵向运动基底部、中间部至心尖部收缩应变的绝对值分别为:20.2±4.2,20.4±4.3,22.5±6.4(P＜0.05);圆周向运动基底部、中间部至心尖部收缩应变的绝对值分别为:20.1±7.7,23.4±8.1,27.1±7.1(P＜0.01),而径向运动的表现则不同,基底部、中间部与心尖部收缩应变的绝对值分别为40.9±17.4,41.8±17.6,28.8±17.1(P＜0.01);3个方向的收缩应变率表现完全不一致,没有明显规律.3个方向舒张早期应变率均表现为自基底部至心尖部递增的趋势.重复性检验提示纵向收缩峰值应变,重复性最佳.结论心肌机械运动是一个极其复杂的过程,二维应变超声心动图有助于揭示生理和病理状态下心肌运动特性.     

应用超声二维应变成像技术评估肥厚型心肌病患者左心室心肌收缩的不同步性

目的 应用超声二维应变成像技术评估肥厚型心肌病(HCM)患者左心室心肌收缩的不同步性.方法 21例肥厚型心肌病患者、21例高血压病患者及21例正常人,分别记录并存储二尖瓣环、乳头肌及心尖部水平左心室短轴二维图像;获取其径向应变和圆周应变曲线.分别测量每个节段从心电图R波到峰值径向应变之间的时间(Trs)和从心电图R波到峰值圆周应变之间的时间(Tcs);并且分别计算每个患者18个节段Trs的标准差(Trs-18SD)和18个节段Tcs的标准差(Tcs-18SD).将HCM组患者所有心肌节段分为肥厚节段与非肥厚节段心肌,比较两组间Trs和Tcs的差异.结果 HCM组患者Trs-18SD明显高于HHD组患者及正常对照组[HCM组: (83±18)ms, HHD组: (52±15)ms, 对照组: (46±9)ms, P<0.001],而高血压组与正常对照组之间无明显差异.HCM组患者Tcs-18SD明显高于HHD组患者及正常对照组[HCM组:(84±18)ms, HHD组:(48±10)ms,对照组:(46±10)ms,P<0.001],而高血压组与正常对照组之间无明显差异.肥厚节段心肌Trs明显低于非肥厚节段心肌(341±42 vs 388±40,P<0.05);而肥厚节段心肌Tcs虽然低于非肥厚节段心肌,但其差异无统计学意义.结论 肥厚型心肌病患者左心室收缩存在不同步性,超声二维应变成像技术为评估左心室收缩不同步性提供了无创性新方法.     

二维应变超声心动图技术对猪心肌挫伤后左室收缩功能的评价

目的探讨二维应变超声心动图在评价猪闭合性心肌挫伤后左室收缩功能中的应用价值。方法采用小型撞击器撞击9只实验猪,建立闭合性心肌损伤模型,应用二维应变技术测量撞击前及撞伤后各时间点左室短轴切面的径向应变（RS）、圆周应变（CS）、旋转角度（ROT）及左室射血分数（LVEF）。结果撞伤前左室心肌各节段RS、CS、ROT无统计学差异（P〉0．05）;撞伤后0．5h、2h、4h、8h、12h左室心肌各节段RS、CS、ROT均较撞伤前下降（P〈0．05）;撞伤后8h、12h LVEF较撞伤前降低（P〈0．05）。结论二维应变技术为定量评价闭合性心肌挫伤后左室收缩功能提供了一种快速、操作简便、无角度依赖的的新方法。     

超声二维应变成像评价肥厚型心肌病患者左心室收缩功能

目的应用超声二维应变成像评价肥厚型心肌病（HCM）患者左室局部心肌收缩功能。方法HCM患者21例，正常对照者21例，获取左室短轴观二尖瓣环水平、乳头肌水平、心尖水平，心尖位四腔观、二腔观及左室长轴观的二维图像，测定左室心尖位二维纵向应变收缩期峰值，左室短轴二尖瓣水平、乳头肌水平、心尖水平各心肌节段心内膜下、心外膜下及整体心肌径向收缩期峰值应变。结果①HCM组与正常组心尖位二维纵向收缩期峰值应变比较，HCM组绝大多数节段心肌峰值应变显著降低（P〈0．05）；②HCM组与正常组左室短轴心内膜下心肌二维径向收缩期峰值应变比较，HCM组心肌收缩期峰值应变明显减低，二尖瓣水平及乳头肌水平绝大多数节段差异有统计学意义（P〈0．05）；③HCM组与正常组左室短轴心外膜下心肌二维径向收缩期峰值应变比较，绝大多数节段差异无统计学意义；④HCM组与正常组左室短轴心肌整体二维径向收缩期峰值应变比较，HCM组绝大多数节段心肌峰值应变显著降低（P〈0.05），尤以肥厚节段较多的乳头肌水平明显（P〈0．01）。结论HCM患者肥厚与非肥厚节段于左室纵向及左室短轴径向收缩功能均受损，并且径向收缩功能受损以心内膜下心肌为主。     

超声及MRI评价右心室心肌应变的临床应用

右心室功能是多种心血管疾病的重要独立预测因子。准确评估右心室功能对临床决策至关重要。超声心动图是临床常用评价心脏结构和功能的方法。心脏MR（CMR）是评价右心室结构和功能的金标准。心肌应变能反映心肌运动功能,是评价右心室早期收缩功能障碍的敏感指标。本文对超声和CMR评价心血管疾病患者右心室心肌应变的临床应用进行综述。     

超声心动图评价高血压患者右室重构与右室功能的研究

目的 探讨超声心动图评价高血压右室重构及右室功能的临床价值.方法 高血压患者62例,按左室重量指数分为无左室肥厚组(A组,33例)和左室肥厚组(B组,29例).对照组为28例健康者.二维超声测量右室前壁厚度(RVAWTd)、右室舒张期内径(RVEDd);三尖瓣反流法估测肺动脉收缩压(PASP);脉冲组织多普勒成像技术(PW-TDI)测量三尖瓣环心肌运动收缩期峰值速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)和S峰速度时间积分(Sm-VTI),分别采用PW-TDI与脉冲多普勒测量右室Tei指数.结果 与对照组比较,A、B组Em和Em/Am下降,Am和Tei指数升高(均P＜0.01);与A组比较, B组Em、Em/Am、Sm下降,Am、Tei指数、RVAWTd及PASP升高(P＜0.05,P＜0.0 1).两种方法所测Tei指数存在相关性:对照组(r＝0.78,P＜0.01),高血压组(r＝0.72,P＜0.01).结论 高血压患者右室功能减低,在左室肥厚同时可发生右室重构并进一步影响右室功能,TDI测定右室Tei指数能简便有效评价高血压右室功能.     

Evaluation of right ventricular and right atrial size in children with atrial septal defect using two-dimensional apex echocardiography

The ability of two-dimensional apex echocardiography to evaluate right ventricular and right atrial size was evaluated in 43 normal children and compared with 20 patients with a secundum atrial septal defect. From the apical four chamber view, the long axis length and short axis diameter of the right ventricle and right atrium were measured. The end-diastolic area of the right ventricle and end-systolic area of the right atrium were determined by planimetry. These data were indexed for body surface area. When compared with normal subjects, the area index of the right atrium and right ventricle were enlarged significantly in patients with a secundum atrial septal defect (p < 0.001 and p < 0.001, respectively). Mean values for the short axis dimension of the right ventricle and for the short axis and long axis diameter of the right atrium were greater in atrial septal defect patients than in normal subjects (p < 0.001 for all). However, when both groups were compared, considerable overlap existed between the dimension measurements. Right ventricular long axis length failed to separate the two groups. Thus, two-dimensional apex echocardiography provides a noninvasive means of assessing right ventricular and right atrial size in children with an atrial septal defect.     

Three-dimensional visual guidance improves the accuracy of calculating right ventricular volume with two-dimensional echocardiography.

Three-dimensional guidance programs have been shown to increase the reproducibility of 2-dimensional (2D) left ventricular volume calculations, but these systems have not been tested in 2D measurements of the right ventricle. Using magnetic fields to identify the probe location, we developed a new 3-dimensional guidance system that displays the line of intersection, the plane of intersection, and the numeric angle of intersection between the current image plane and previously saved scout views. When used by both an experienced and an inexperienced sonographer, this guidance system increases the accuracy of the 2D right ventricular volume measurements using a monoplane pyramidal model. Furthermore, a reconstruction of the right ventricle, with a computed volume similar to the calculated 2D volume, can be displayed quickly by tracing a few anatomic structures on 2D scans.     

二维斑点追踪成像技术评价糖尿病患者前期右心室纵向应变及应变率

目的采用二维斑点追踪成像技术评估糖尿病前期患者右心室功能的损害。 方法选取2012年6月至2016年5月在台州恩泽医疗中心（集团）浙江省台州医院就诊的患者110例：健康对照组40例,糖尿病前期33例,2型糖尿病37例,测量右心室常规超声参数,并采用二维斑点追踪成像技术测量右心室游离壁纵向峰值应变（RVLPSF）、室间隔纵向峰值应变（RVLPSS）、右心室整体纵向峰值应变（RVLPSG）及右心室整体收缩期应变率（SRS）、舒张早期应变率（SRE）、舒张晚期应变率（SRL）。3组患者LVEDVI、LVESVI、LVEF、RVD、E/A、e/a、E/e、TAPSE、RVFAC、RVLPSF、RVLPSS、RVLPSG、SRS、SRE、SRL等测值比较,采用LSD-t检验。 结果与健康对照组比较：糖尿病前期组RVLPSF、RVLPSS、RVLPSG、SRS、SRE测值明显减低,差异均有统计学意义[（-27.89±4.11）% vs（-21.78±3.62）%,（-20.08±4.11）% vs（-16.88±2.68）%,（-23.98±2.96）% vs（-19.33±2.13）%,-1.67±0.25 vs -1.18±0.24,1.84±0.23 vs 1.35±0.20,t=3.45、3.42、3.44、3.44、3.43,P均<0.01];糖尿病组RVLPSF、RVLPSS、RVLPSG、SRS、SRE测值明显减低,差异有统计学意义[（-27.89±4.11）% vs（-20.97±3.88）%,（-20.08±4.11）% vs（-15.42±1.92）%,（-23.98±2.96）% vs（-18.19±2.29）%,-1.67±0.25 vs -1.08±0.23,1.84±0.23 vs 1.18±0.27,t=3.43、3.45、3.43、3.42、3.42,P均<0.01]。与糖尿病前期组比较：糖尿病组SRE明显减低,差异有统计学意义（1.35±0.20 vs 1.18±0.27,t=3.45,P <0.01）。 结论在糖尿病前期右心室的舒张功能与收缩功能已受到损害,斑点追踪成像可定量评估这种损害程度。