实时三维超声心动图评价右室收缩功能的初步临床研究

目的 应用实时三维超声心动图(RT-3DE)检测右室收缩功能,并与传统二维超声心动图对照,探讨该技术的可行性与准确性。方法 使用RT-3DE系统采集32例健康志愿者的右室“金字塔”型数据库,结合容积分析软件,采用心尖八平面法勾勒右室舒张末期容积(RVEDV)和收缩末期容积(RVESV),并计算右室每搏量(RVsV)和射血分数(RVEF);同时在M型超声心动图上测量右室游离壁三尖瓣环处的收缩期位移(TASE)、二维超声心动图上勾画右室面积变化分数(FAC),比较三维容积法测定的收缩指数与TASE、FAC间的相关性。结果 RT-3DE测量的RVSV、RVEF均与TASE呈显著正相关(r=0．90;r=0．83);RVEF与FAC之问呈正相关(r=0．63)。结论 实时三维超声容积成像能快速简便、准确无创地确定右室容积,为临床早期评估右心收缩功能提供了有力手段,具有极其广阔的发展前景。     

实时三维超声心动图评价先天性心脏病患者右室功能变化的研究

目的 探讨实时三维超声心动图测量右室容积及右室射血分数评价先天性心脏病右室扩大病人的右室功能变化。方法 分别应用实时三维超声心动图及常规二维超声心动图测量30例正常人与25例先天性心脏病右室扩大病人的右室收缩末期及舒张末期容积(RVESV和RVEDV)、右室射血分数(RVEF)、右室重量(RVmass)。结果 ①正常人组内将三维超声心动图测量的RVESV、RVEDV、RVEF、RVmass与二维超声心动图的测值进行比较无统计学差异；将先天性心脏病患者的二维、三维超声心动图测值进行比较也无统计学差异。②正常人组的二维、三维超声心动图测量值RVESV、RVEDV、RVmass均较先天性心脏病病人测值低，而RVEF测值较病人高。③二维、三维超声心动图测量的RVEDV的相关关系(r=0．934)。结论实时三维超声心动图能通过测量正常人与先天性心脏病右室扩大病人的右室容积、射血分数及右室质量来评价先天性心脏病右室扩大病人的右室功能。     

多普勒超声右室流出道血流参数评价肺心病右室收缩功能

目的：探讨多普勒超声右室流出道血流参数对评价肺心病右室收缩功能的价值。方法：在22例肺心病患者中,利用脉冲多普协超声记录右室流出道（RVOT）血流频谱参数,与放射性核素心室造影测算的右室射血分数（RVEF）对比分析。结果：在RVOT血流参数中右室收缩时间间期（STI）,射血期流速积分（VTI）和平均血流速度（Vm)与核素造影所测RVEF仅有轻度相关,其余测值无相关。结论：肺心病患者的RVOT血流参数难以反映右室收缩功能情况。     

多普勒获取右室收缩时间间期评价右室收缩功能

本文研究目的应用多普勒获取右室收缩时间间期与超声心动图估测右室射血分数（ＲＶＥＦ）作相关分析。结果表明：应用多普勒获取ＰＥＰ／ＲＶＥＴ、Ｑ－Ｖｐｅａｋ、ＲＶＥＴ／ＴＲ－ｄ及校正Ｑ－Ｖｐｅａｋ、ＲＶＥＴ／ＴＲ－ｄ与超声心动图估测ＲＶＥＦ存在良好线性相关（ｒ分别为－０．７５，０．４８，０．６４，－０．５７，０．５８），因此多普勒获取上述指标可用于评价右室收缩功能。     

多平面经食管体元模型动态三维重建评价右心室射血分数的临床应用

本研究应用多平面经食管体元模型动态三维重建的方法测量8例健康志愿者和9倒房间隔缺损患者右室腔容积和右室射血分数，结果显示，房间隔缺损患者的右室腔三维形态与正常人相似，但比正常人饱满，表面乳头肌和肌小梁的压迹与正常人相仿，室间隔面仍然凹进，短轴截面基本为半月形。正常人右室舒张末期和收缩末期容积分别为37．82±10．6ml／m2和19．84±5．93ml／m2，房间隔缺损患者则分别为101．06±48．81ml／m2和52．69±31．02ml／m2，较正常人的右室容积均高（P＜0．01和P＜0．05），但EF值在正常人（0．48±0．04）和房间隔缺损患者（0．49±0．07）之间无明显差别（P＞0．05）。本研究建立了超声技术测定右室射血分数的方法，为无创伤性右心功能评价开辟了新途径。     

Influence of constant sustained positive airway pressure on right ventricular performance

Objective The detrimental effect of positive airway pressure on right ventricular (RV) performance is controversial and the aim of this study was to determine the effects of constant positive airway pressure without ventilatory fluctuation on RV performance with the aid of a pulmonary arterial catheter equipped with a rapid response thermistor for measuring RV ejection fraction (RVEF) and RV end-diastolic volume index (RVEDVI).Design A prospective, clinical study.Setting The central operating theatre of a university hospital.Patients Nine patients who had major surgery and required right heart catheterization for normal clinical management.Measurements and results Cold indicator was injected into the RV 4 or 5 times for each airway pressure (0, 10 or 20 cmH₂O) which was maintained manually stable for 15 s, and 9 paired data were analyzed by repeated-measures analysis of variance. They are separated into two groups; RVEF at zero airway pressure greater (A group) or less (B group) than 0.4. In A group (7 patients), increasing airway pressures (0 vs 10 vs 20 cmH₂O) did not affect RVEF (0.55±0.05 vs 0.54±0.06 vs 0.56±0.04), RVEDVI (69±36 vs 73±29 vs 58±20 ml·m^–2), or stroke volume index (SVI: 38±18 vs 40±17 vs 33±13 ml·beat^–1 ·m^–2); however, in B (2 patients), RVEF (0.35 and 0.38 vs 0.31 and 0.28 vs 0.19 and 0.17) and SVI (35 and 28 vs 32 and 27 vs 27 and 23) decreased, while RVEDVI increased (99 and 73 vs 103 and 97 vs 146 and 132).Conclusions In most patients, the changes in RVEF, SVI, and RVEDVI did not occur under constant positive airway pressure, therefore the changes reported in mechanically ventilated patients may not attributable to the extent of positive airway pressure but rather to abrupt increases in airway pressure. There appears, however, to be patients whose RV function is so disturbed that they cannot cope with increased afterloads.     

Right ventricular function in COPD patients during weaning from mechanical ventilation

We studied the right ventricular function during a successful weaning period in 7 COPD patients without LV disease who had been mechanically ventilated for several days after an acute exacerbation of their disease. A Swan-Ganz ejection fraction thermodilution catheter performed measurements of right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI) before and fifteen minutes after disconnection from the ventilator at the maintenance FiO₂. Although pulmonary artery pressure (PAP) rose from 25±4 to 28.5±4.5 mmHg after disconnection from the ventilator, RVEF (0.36±0.56 to 0.35±0.12) and RVEDVI (117±51 to 126±52 ml/m²) remained similar in both conditions. We concluded that right ventricular systolic function assessed with modified pulmonary artery catheter was maintained during the weaning phase in such weanable patients. This method could easily detect any fall of RVEF or diastolic RV enlargement able to impair the weaning in some patients.     

新技术声学定量在估测右心功能中的应用

本文利用声学定量（ＡＱ）技术初步测量了２９例正常人及１１例门诊患者的右室面积和变化率。结果表明，观察者之间及观察者本身的变异性均较小，不同观察者同一时间及同一观察者不同时间所测右室面积诸值间无显著性差别（Ｐ＞０．０５）。在４０例受检音中，ＡＱ法所测右室收缩舒张末面积、面积变化率与脱机手工测值高度相关（ｒ＝０．７０～０．９８）。由此可见，ＡＱ技术用于测量右心功能是可行的。     

六种超声方法估测左室射血分数的准确性比较

本文对５２例心脏病患者进行两维超声心动图检查，利用６种测左室射血分数（ＬＶＥＦ），并与平衡法核素心室造影获得的ＬＶＥＦ进行直线相关分析及配对ｔ检验。结果显示：６种超声方法获得的ＬＶＥＦ均与核素ＬＶＥＦ高度相关。其中尤以双平面Ｓｉｍｐｓｏｎ法获得的ＬＶＥＦ与核素ＬＶＥＦ相关最佳。但６种超声方法ＬＶＥＦ测值均低于核素ＬＶＥＦ，其中３种超声方法测得的ＬＶＥＦ与核素ＬＶＥＦ有显著性差异。     

Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS

Eight patients who developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI₂, 12.5–35.0 ng·kg^–1·min^–1) for 45 min. We examined whether reducing the right ventricular (RV) outflow pressures by PGI₂ infusion would increase the right ventricular ejection fraction (RVEF) measured by thermodilution. PGI₂ reduced the pulmonary artery pressure (PAP) from 35.6 to 29.1 mmHg (p<0.01). The cardiac index (CI) increased from 4.2 to 5.81·min^–1·m^–2 (p<0.01) partly due to an increased stroke volume. The decreased PAP together with the increased CI resulted in a fall of the calculated pulmonary vascular resistance index (PVRI, from 5.1 to 2.5 mmHg·min·m²·1^–1,p<0.01). In the patients with subnormal baseline RVEF the increased stroke volume was associated with an increased RVEF (from 47.6% to 51.8%,p<0.05) suggesting improved RV function. This result was underscored by a significant relationship between the changes in PVRI and RVEF (r=0.789, % RVEF=–2.11·PVRI-1.45). Despite an increased venous admixture from 27.8% to 36.9% (p<0.05) the arterial PO₂ remained constant resulting in an increased oxygen delivery from 657 to 894 ml·min^–1·m^–2 (p<0.01). We conclude that short term infusions of PGI₂ increased CI concomitant to improved RV function parameters when baseline RVEF was depressed. Since improved oxygen availability should be a major goal in the management of patients with ARDS PGI₂ may be useful to lower pulmonary artery pressure in ARDS.Supported by the Deutsche Forschungsgemeinschaft (grant Fa 139/2-2)     

右心声学造影时间-强度曲线参数与心肌运动指数评价右心收缩功能的实验研究

目的　探讨心腔声学造影时间-强度曲线( TIC)各项参数与心肌运动指数定量评价右心收缩功能的价值。方法　对1 0只犬分别在基础状态及注射心得安后心功能减退状态下经股静脉重复注射5 %声振白蛋白注射液,剂量0 .0 8ml/kg。于心尖四腔切面观察右心室造影剂的充盈及清除,采用拟合曲线定量分析方法获取心腔声学造影TIC各项参数,并分析各项参数在不同的心功能水平的差异。应用多普勒超声心动图分别在基础状态及注射心得安后心功能减退状态下记录三尖瓣舒张期和右心室流出道收缩期脉冲多普勒血流频谱,测量心肌运动指数( MPI,即Tei指数) ,MPI为心室等容舒张期时间及等容收缩期时间之和与心室射血时间的比值。结果　随心功能的减退,TIC各项参数中时间常数( k)明显减小,而造影剂峰值强度减半时间( HT)及造影剂平均渡越时间( MTT)明显延长,P值均小于0 .0 0 1。时间常数( k)与心肌运动指数( MPI)明显负相关,相关系数为- 0 .76。结论　右心腔声学造影时间-强度曲线参数与MPI在定量评估右心收缩功能时具有重要价值     

实时三维超声心动图对扩张型心肌病右心室整体收缩功能的评价

目的：应用实时三维超声心动图（RT-3DE）技术评价扩张型心肌病（DCM）患者右心室整体容积及收缩功能。方法：51例经临床诊断证实的DCM患者,经二维超声（2DE）筛选出DCM1组（右心室内径正常者）41例和DCM2组（右心室扩大者）10例,36例年龄相匹配的健康志愿者为对照组,均行三维容积成像并应用四维右室功能（4D-RVF）分析软件计算右室整体舒张末期容积（RVEDV）、收缩末期容积（RVESV）及射血分数（RVEF）,分别进行各组间比较。结果：DCM组与正常对照组比较：前者RVEDV、RVESV均显著增高,而RVEF值则显著降低（P值均〈0．001）。DCM两纽间比较：DCM1组RVEDV及RVESV显著低于DCM2组（P值均〈0．05）,但RVEF两组间无显著差异（P=0．31）。结论：DCM患者即使2DE检查右室内径正常,其容积与正常比较也已增大,甚至右室功能已明显减退。运用4D-RVF能准确评估右室功能,方法简便、易行。     

Monitoring of right ventricular function using a conventional slow response thermistor catheter

Objective To investigate whether determination of right ventricular end-diastolic volume (RVEDV) and right ventricular ejection fraction (RVEF) can be performed with reasonable accuracy and reproducibility using a conventional slow response thermistor pulmonary artery catheter (CPAC) applying an adaptive algorithm.Design To study RVEDV and RVEF simultaneously with pulmonary artery catheters equipped with slow and fast response thermistors (FRPAC) under a broad range of cardiac output.Setting Laboratory of Institute of Experimental Surgery, Technical University.Animals 11 anaesthetised piglets.Interventions Hypovolemia (V–) was induced by withdrawal of blood up to 50 ml/kg, hypervolemia (V+) was produced by retransfusing blood and adding up to 30 ml/kg hydroxyethyl starch. In 5 animals in phases V–and V+ beta-adrenergic stimulation was achieved with dobutamine. Finally pulmonary artery hypertension was induced by infusion of small air bubbles.Measurements and results Cardiac output (CO), RVEDV and RVEF were determined simultaneously with FRPAC and CPAC placed in the same pulmonary artery branch. Measurements were repeated 8 times sequentially in steady state normovolemia. A total of 130 measurements could be analysed. The coefficient of variation was 6.7±4.2 for CO_(FRPAC) and 4.6±1.7% for CO_(CPAC); for RVEF it was 9.7±6.2% (FRPAC) and 9.9±3.9% (CPAC); for RVEDV it was 11.6±4.8% (FRPAC) and 8.54±3.2 (CPAC). Mean difference (bias) was 0.06±0.39 l/min for CO measured with both methods, 19±35 ml for RVEDV and –3.3±6.5% for RVEF. CO_(CPAC) displayed a strong correlation to CO_(FRPAC) (R=0.97,p=0.001) as well as RVEF (R for RVEF_(CPAC) versus RVEF_(FRPAC)=0.90,p=0.001). R for RVEDV_(CPAC) versus RVEDV_(FRPAC) was 0.67,p=0.001. We conclude that this animal study demonstrates good agreement between RVEF and RVEDV obtained with catheters equipped with a fast response thermistor or with a conventional slow response thermistor allowing accurate monitoring of right ventricular function with a conventional pulmonary artery catheter.Supported in part by grants from BMFT (grant number 0706908)     

实时三维超声心动图评价房间隔缺损右心室整体及节段收缩功能

目的探讨实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)评价房间隔缺损患者右心室整体及节段收缩功能的可行性及准确性。方法使用RT-3DE采集27例房间隔缺损(atrial septal defect,ASD)患者和32例健康志愿者心脏全容积图像,应用Tomtec公司的Manual4D RV-Function CAP分析软件测量右心室整体及3节段收缩功能,得到右心室整体和节段舒张末期容积、收缩末期容积,射血分数,并通过软件自动生成右室节段容积-时间变化曲线。结果RT-3DE可以同步评价右心室整体及节段收缩功能。ASD患者的右室收缩功能下降(P=0.017),3节段中流出道部和小梁部的收缩功能下降最为明显(P=0.036,0.008),流入道部收缩功能下降无统计学意义(P=0.554)。结论RT-3DE可有效评价右室整体及节段收缩功能,对于房间隔缺损患者的手术治疗及预后评价有重要意义。     

右心室射血分数与肺切除术后并发症的相关性分析

目的:探讨术前右心室射血分数(right ventricular ejection fraction,RVEF)与肺切除术后并发症的关系。方法:选取上海交通大学胸科医院胸外科2011年7月—2012年3月肺叶或全肺切除术患者216例,应用实时三维多普勒超声心动图连续对患者行术前RVEF测定。患者术前均行肺功能测定。分析RVEF与术后并发症的关系。结果:肺叶切除组RVEF45%的患者和RVEF≥45%的患者肺功能及术后并发症发生率差异均无统计学意义(P均0.05)。全肺切除组RVEF45%的患者和RVEF≥45%的患者肺功能差异无统计学意义(P0.05),而术后并发症发生率差异有统计学意义(P0.05)。结论:术前RVEF45%是全肺切除术后出现并发症的危险因素。     

Correlation of right ventricular ejection fraction and tricuspid annular plane systolic excursion in tetralogy of Fallot by magnetic resonance imaging

The correlation between right ventricular ejection fraction (RVEF) and tricuspid annular plane systolic excursion (TAPSE) by two-dimensional (2-D) echo has been repeatedly validated, but not by magnetic resonance imaging (MRI) nor in patients with congenital heart disease. We tested whether TAPSE measurements by MRI correlate with RVEF in surgically repaired tetralogy of Fallot (TOF) patients. TAPSE was measured from systolic displacement of the RV-freewall/tricuspid annular plane junction in the apical 4-chamber view in 7 normal subjects and 14 TOF patients. The RV was reconstructed in 3-D from manually traced borders on MR images to compute true EF. Because we previously observed discrepancy between TAPSE and RVEF in the presence of regional dysfunction, we also analyzed RV wall motion in terms of regional stroke volume at 20 short axis slices from apex to tricuspid annulus. RVEF was 52 ± 3% in normal subjects and 41 ± 9% in TOF (P < 0.01). TAPSE correlated weakly (r = 0.50, P < 0.05) with RVEF. TOF patients exhibited increased regional stroke volume from apical portions of the RV and decreased regional stroke volume at the base compared to normal (P < 0.05 at 15 of 20 slices). Regional stroke volume in apical slices correlated inversely with RVEF such that patients with higher apical stroke volume had lower RVEF (P < 0.05). TAPSE is not a reliable measure of RVEF in TOF by MRI. TAPSE may be of limited use in conditions that exhibit abnormal regional contraction.     

斑点追踪法三尖瓣环位移评估肺高血压患者的右心室功能

目的：探讨二维斑点追踪技术测定肺高血压（简称肺高压）患者的三尖瓣环位移（tricuspidannulardisplacement,TAD）在评估右心室收缩功能方面的临床应用价值。方法：将经胸超声诊断为肺高压的患者共61例分为3个亚纽：I组（可疑肺高压,n=21）,II组（肯定肺高压,n=20）,Ⅲ组（重度肺高压,n=20）。另选35例年龄相匹配的健康志愿者作对照组。用PhillipSonosiE33超声仪,取心尖四腔观先后采集二维（2D）及实时三维（real—timethree—dimension,RT3D）图像,然后将2D图像输入QLAB6．2工作站获取三尖瓣环中点收缩期位移等参数;将RT3D图像输入TomTec工作站,用四维右心室功能分析（4DRVF）软件计算右心室射血分数（RVEF）。结果：TAD各测值与肺动脉收缩压（PASP）中度相关,与3D-RVEF高度相关。肺高压患者TAD各测值均显著低于对照组,各个亚组间TAD各测值比较差异也有统计学意义。TAD在观察者间及观察者内的差异范围分别为（0．05±1．75）mm及（-0．15±1．09）mm。结论：用二维斑点追踪显像技术测定TAD具有快速、准确及重复性好等特点,TAD能客观反映肺高压患者的右心室收缩功能。     

风湿性二尖瓣狭窄患者右室收缩功能的定量组织速度成像评价

目的定量组织速度成像评价风湿性二尖瓣狭窄(MS)合并三尖瓣返流(TR)患者右室收缩功能及其影响因素。方法选择58例MS合并TR患者和30例正常人进行研究,测量右室收缩横径(RVD),应用定量组织速度成像(QTVI)测量右心室游离壁基底段收缩期峰值速度(Vs)。MS患者测量三尖瓣返流速度,估测肺动脉收缩压(PASP);PASP轻度升高(30~50mmHg)的患者为A组,PASP中重度升高(>50mmHg)的患者为B组。测量三尖瓣反流面积(TRA)与右房面积(RAA),计算TRA/RAA比值反映三尖瓣反流程度。结果与对照组相比较,A组、B组Vs测值降低(P<0.05,P<0.01),RVD测值增大(P<0.01,P<0.01)。B组较A组Vs测值降低(P<0.05),RVD、TRA/RAA增大(P<0.01,P<0.01)。Vs与PASP、RVD、TRA/RAA均呈负相关(r=-0.30,P<0.05;r=-0.28,P<0.05;r=-0.42,P<0.01)。结论MS患者存在右室收缩功能降低,右室功能与肺动脉压、右室径、三尖瓣反流密切相关。     

Study of right ventricular function in ischaemic heart disease using radionuclide angiocardiography

A technique for the estimation of LVEF from first passage radionuclide angiocardiography was adapted to provide estimates of RVEF. In 17 subjects with no history of cardiovascular disease mean LVEF was 0.71±0.08 and mean RVEF 0.65±0.08. Mean values for 15 subjects with coronary artery disease but no previous history of myocardial infarction were 0.66±0.10 for LVEF and 0.65±0.08 for RVEF. Depressed ejection fractions were found after acute myocardial infarction. LVEF was lower after anterior (0.43±0.06) than inferior (0.51±0.10) infarction. RVEF was normal in the majority of subjects with anterior infarction (0.58±0.10) but was depressed after inferior infarction (0.50±0.05). Similar, although less marked, results were found in a group of subjects with old myocardial infarction.