Background Early and accurate assessment of right ventricular changes in patients with Chronic obstructive pulmonary disease(COPD)is of great value,because these changes are important factors affecting the prognosis o...Background Early and accurate assessment of right ventricular changes in patients with Chronic obstructive pulmonary disease(COPD)is of great value,because these changes are important factors affecting the prognosis of patients with COPD. This study aimed to investigate the changes of right ventricular structure and function by electrocardiography in COPD patients,and to evaluate the correlations of pulmonary function,COPD assessment test(CAT)score with the changes. Methods According to the"ABCD"2016 Global initiative for chronic obstructive pulmonary disease(GOLD)update,stable COPD patients were divided into four groups:GOLD A group,GOLD B group,GOLD C group,and GOLD D group. There were 30 patients of each group enrolled from December 2016 to December 2017 in Guangdong General Hospital. During the same period,30 physical examination volunteers were enrolled as the healthy control group. Pulmonary function and echocardiography were performed in all subjects. All COPD patients completed CAT test. One-way ANOVA and SNK-q test were used to analyze the differences in parameters of right ventricular structure and function between different GOLD groups and healthy controls. Pearson correlation analysis was used to analyze the relation between CAT score,forced expiratory volume in one second(FEV1)and echocardiographic parameters. Results Compared with control group,right ventricular wall thickness(RVWT)was significantly thicker in patients of GOLD A,B and C groups(P<0.001),but not for GOLD D group. In sharp contrast,only in the patients of GOLD D group,right ventricular basal diameter(RV basal diameter)and right ventricular outflow tract(RVOT)(2.84±0.56 cm and 4.63±0.54 cm)were significantly longer than those in healthy controls and other GOLD groups(P<0.001).The patients of GOLD C and D groups had higher E/A ratio and E/e′ ratio compared with control group,GOLD A and B groups(P<0.001). But only in GOLD D group,the fractional area change(FAC)and tricuspid annular plane systolic excursion(TAPSE)were decreased significantly,compared with control group and other GOLD groups(P<0.001). The right ventricular index of myocardial performance(RIMP)in GOLD B,C and D groups was increased significantly compared with healthy control and GOLD A group(P<0.001). Moreover,correlation analysis showed that no correlations were found between FEV1 and all parameters of right ventricular structure and function,but CAT was positively correlated with RIMP(r=0.696,P=0.019). Conclusions Echocardiography could be a good assessment for right ventricular structure and function in COPD patients. Right ventricular wall thickening and diastolic dysfunction occur in the early stage of COPD,followed by right ventricular volume enlargement and systolic dysfunction.展开更多
Objective Assessment of right ventricular function in patients with atrial septal defect(ASD)is difficult.The Doppler myocardial performance index(MPI)may provide a method of assessing function in these patients.The p...Objective Assessment of right ventricular function in patients with atrial septal defect(ASD)is difficult.The Doppler myocardial performance index(MPI)may provide a method of assessing function in these patients.The purposes of this study were to evaluate the right ventricular function and its changes in patients with ASD after transcatheter closure of ASD.Methods MPI,defined as the sum of isovolumic relaxation time and isovolumic contraction time derived by ejection time,was measured from tricuspid inflow and right ventricular outflow;Doppler velocity profiles recorded during routine echocardiography.Twenty nine patients(13 men,16 women;mean age 25.28±12.69,range 6 to 57 years)were diagnosed to secundum ASD[the stretched diameters of ASD were from 9 To 36(24.91±7.98)mm],and had a successfully placed Amplatzer septal occluder(ASO)(the sizes of ASO were from 11 to 40 mm);there were 81 sex-matched,age-matched healthy people(control group 41men,40 women;mean age 29.02±14.22,range 4 to 45 years).MPI was measured again on 3 days and 1 month after closure of ASD.Change in the study group was assessed and compared to the control subjects with structurally normal hearts.A complete 2-dimensional and Doppler echocardiographic examination was performed in all study groups.Results 1)The isovolumic relaxation and isovolumic contraction times[respectively(77.59±14.39)ms vs(60.93±12.94)ms,P<0.0001;(28.28±10.88)ms vs(23.64±9.01)ms,P=0.027]were prolonged,and ejection time[(260.65±21.86)ms vs(271.85±21.92)ms,P=0.033]was shortened in patients with ASD compared with that in control subjects,resulting in a marked increase in the MPI(0.40±0.07 vs 0.31±0.05,P<0.0001)from normal values;2)by Pearson's correlations,the MPI had no correlation with heart rate and blood pressure in control subjects and patients with ASD,but it correlated positively with age in patients with ASD;3)by Pearson's correlations,the MPI correlated positively with the diameter of ASD and pulmonary artery pressure;4)after transcatheter closure of ASD,the MPI decreased markedly.Conclusions 1)MPI is a conceptually new,simple,and reproducible Doppler index in patients with ASD;2)MPI is free from the effect of age,heart rate and blood pressure;(3)MPI appears to be relatively dependent on changes in the diameter of ASD and pulmonary artery pressure;4)the right ventricular function was improved after transcatheter closure of ASD.展开更多
Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular （RV） function in atrial septal defect （ASD）. Methods Tissue Doppler images （TDI） of R...Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular （RV） function in atrial septal defect （ASD）. Methods Tissue Doppler images （TDI） of RV longitudinal and short axes were recorded from the apical 4-chamber view and the subcostal short-axis view in 18 normal controls, 28 children with ASD and 14 children after Amplazter closure of ASD respectively. Peak systolic velocities （ V）, peak systolic strain rates （SR）, peak systolic strains （S） at the basal segment, middle segment of RV lateral wall and the basal septum from the longitudinal axis, the middle segment of RV free waU from the short axis were quantitatively measured using QLAB^TM tissue velocity quantification software system respectively. Peak dp/ dt from the RV isovolumic contraction determined during the right cardiac catheterization in 28 ASD patients was used as the gold standard of RV contractility. Peak systolic indices were compared against max dp/dt by linear correlation, Results Peak systolic indices at the basal and middle segments of RV lateral wall from the longitudiual axis increased significantly in 28 ASD patients. Peak systolic indices at the basal septum also increased in patient group, but not significantly. Significant decreases in peak systolic indices at the basal and middle segments of RV lateral wall were observed after the Amplatzer closure in 14 ASD patients. There was no significant difference at the middle segment of RV free wall from the short axis between patient group and normal control. A strong correlation was found between max dp/dt and peak systolic indices at the basal and middle segments of RV lateral wal l （ P 〈 0. 05 ）. Conclusion Ultrasound-based strain rate imaging can assess quantitatively RVfunction in CHD. Peak systolic strains determined at the basal and middle segments of RV lateral wall are strong noninvasive indices of RV contractility.展开更多
Objective Dilated cardiomyopathy(DCM) is generally considered to be accompanied by both left and right ventricular dysfunction,but most studies only analyze the left ventricular function. In this study,we evaluated th...Objective Dilated cardiomyopathy(DCM) is generally considered to be accompanied by both left and right ventricular dysfunction,but most studies only analyze the left ventricular function. In this study,we evaluated the effect of arotinolol on right ventricular function in patients with DCM. Methods Right ventricular ejection fraction(RVEF) and right ventricular diameter(RVD) were measured by two-dimensional echocardiography(2-DE) in 33 DCM patients;RVEF measured by first-pass radionuclide angiography(FPRA) was compared with that by 2-DE. Results The treatment with arotinolol for one year resulted in a reduction in the right ventricular diameter(baseline,23.0 ± 8.3 mm vs after one-year treatment,20.7 ± 5.4 mm;P=0.004 ) and an associated increase in ejection fraction(baseline,36.9 ± 10.3% vs after one-year treatment,45.8 ± 9.6%;P < 0.001 ) ;there is a high correlation between the 2-DE method and radionuclide ventriculographic method. The correlation coefficient is 0.933(P<0.001) . Conclusion Arotinolol therapy could not only improve left ventricular function,but also improve right ventricular function in DCM patients.展开更多
Objective:To investigate the effect of early intervention of Tongxinluo(通心络,TXL)on right ventricular function(RVF)of rats with pulmonary arterial hypertension(PAH)induced by monocrotaline(MCT).Methods:A total of 30...Objective:To investigate the effect of early intervention of Tongxinluo(通心络,TXL)on right ventricular function(RVF)of rats with pulmonary arterial hypertension(PAH)induced by monocrotaline(MCT).Methods:A total of 30 adult male Sprague-Dawley rats were assigned to 5 groups with complete random experiment design:Sham group(Sham),MCT group,TXL group,sildenafil(SIL)group and combination group(TXL+SIL),6 rats in each group.Rats were injected with 50 mg/kg MCT solution for inducing PAH model except for those in the sham group.From the day of modeling,rats of TXL,SIL and TXL+SIL groups were given TXL(1.2 g/kg),SIL(10 mg/kg)and combination solution(TXL:1.2 g/kg,SIL:10 mg/kg)respectively,and rats in Sham and MCT groups were given normal saline(5 m L/kg).The samples were collected and tested after 21 consecutive days of intragastric administration.Echocardiography was used to measure the related indices of RVF,including pulmonary arterial flow spectrum,pulmonary artery diameter(PAD),right ventricular wall thickness(RVWT),right ventricular diameter(RVD),tricuspidannular plane systolic excursion(TAPSE),right atrium transverse diameter(RAT),and inferior vena cava diameter(IVCD).Elastic Verhoeff-Van Gieson staining was adopted to measure the percentage of wall thickness(WT%)of pulmonary arteriols.Hematoxylin-eosin staining was used to measure the cross-sectional area(CSA)of right ventricular cardiomyocytes.Results:MCT-induced PAH rat model was successfully established.In MCT group the wall of pulmonary arterioles exhibited a prominent-increase thickness,PAD,RVWT,RVD,RAT,IVCD,WT%,right ventricular hypertrophy index(RVHI)as well as CSA of RV cardiomyocyte significantly increased(all P<0.01),and TAPSE markedly decreased(P<0.01).At the same time,TXL prominently improved all of the above indices(all P<0.01).In comparison with SIL,TXL significantly reduced RVD(P<0.05)and decreased CAS of RV cardiomyocytes(P<0.01),but TAPSE in SIL group was much larger than in TXL group(P<0.01).Moreover,TAPSE in TXL+SIL group was larger than that in TXL group(P<0.01),while the two groups performed equally well in terms of the other indices.Conclusion:Early intervention of TXL could inhibit pulmonary arterioles remodeling,and improve RVF by attenuating right ventricular hypertrophy,and TXL has a stronger effect on inhibiting right ventricular remodeling than SIL.展开更多
Right ventricular function is independently associated with poor clinical outcomes in patients with various cardiovascular diseases including pulmonary hypertension(PH).The complex geometry and mode of contractility m...Right ventricular function is independently associated with poor clinical outcomes in patients with various cardiovascular diseases including pulmonary hypertension(PH).The complex geometry and mode of contractility means the right ventricle(RV)inlet and outlet are not in line;hence,2-dimensional echocardiography fails to accurately quantify RV volumes and function in such patients.Three-dimensional echocardiography(3DE)allows for reliable and reproducible quantification of RV volumes and function by overcoming these limitations of conventional echocardiography.This review focuses on the 3DE assessment of RV function in patients with PH and discusses the following points:(1)acquiring an RV data set for 3DE imaging,including details of all available 3DE systems and software utilized in daily practice;(2)the reliability and feasibility of RV remodeling measured with 3DE with different modalities in patients with PH;and(3)the prognostic value of 3DE-derived RV function in such patients.展开更多
The optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function...The optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function was assessed. RV “Full volume” images were acquired by RT3DE in 22 healthy subjects. RV end-diastolic volumes (RVEDV) and end-systolic volumes (RVESV) were outlined using apical biplane, 4-plane, 8-plane, 16-plane offline separately. RVSV and RVEF were calculated. Meanwhile tricuspid annual systolic excursion (TASE) was measured by M-mode echo. LVSV was outlined by 2-D echo according to the biplane Simpson's rule. The results showed: (1) There was a good correlation between RVSV measured from series planes and LVSV from 2-D echo (r=0.73; r=0.69; r=0.63; r=0.66, P<0.25—0.0025); (2) There were significant differences between RVEDV in biplane and those in 4-, 8-, 16-plane (P<0.001). There was also difference between RV volume in 4-plane and that in 8-plane (P<0.05), but there was no significant difference between RV volume in 8-plane and that in 16-plane (P>0.05); (3) Inter-observers and intro-observers variability analysis showed that there were close agreements and relations for RV volumes (r=0.986, P<0.001; r=0.93, P<0.001); (4) There was a significantly positive correlation of TASE to RVSV and RVEF from RT3DE (r=0.83; r=0.90). So RV volume measures with RT3DE are rapid, accurate and reproducible. In view of RV's complex shape, apical 8-plane method is better in clinical use. It may allow early detection of RV systolic function.展开更多
Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in...Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot(TOF)by 2-dimensional ultrasound speckle tracking imaging(STI).Thirty-eight patients with TOF were enrolled in this study and divided into child group(n=25)and adult group(n=13)according to age.Thirty-eight age-and sex-matched normal subjects were selected as c...展开更多
Summary: To study reliability and reliable indices of quantitative assessment of right ventricular systolic function by time-intensity curve (TIC) with right ventricular contrast, 5 % sonicated human albumin was injec...Summary: To study reliability and reliable indices of quantitative assessment of right ventricular systolic function by time-intensity curve (TIC) with right ventricular contrast, 5 % sonicated human albumin was injected intravenously at a does of 0.08 ml/kg into 10 dogs at baseline status and cardiac insufficiency. Apical four-chamber view was observed for washin and washout of contrast agent from right ventricle. The parameters of TIC were obtained by curve fitting. The differences of parameters were analyzed in different states of cardiac functions. Among the parameters derived from TIC, the time constant (k) was decreased significantly with decline of cardiac function (P<0.001). But half-time of decent of peak intensity (HT) and mean-transit-time (MTT) of washout were increased significantly (P<0.001). The k was strongly related to cardiac output of right ventricle (CO) and ejection fraction (EF) of left ventricle and fractional shortening (FS) of left ventricle. Right ventricular systolic function could be assessed reliably by the parameters derived from TIC with right ventricular contrast echocardiography. The k, HT and MTT are reliable indices for quantitative assessment of right ventricular systolic function.展开更多
BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foeta...BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart,affecting foetal circulation.The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus(DV).AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls.The DV flow velocities and velocity ratios were measured.The early passive/late active(E/A)ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.RESULTS During the third trimester,the isolated SUA group showed a lower‘a’-wave peak velocity in the DV than the control group(P<0.05).The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best(R^2of the isolated SUA group:0.520;R2 of the control group:0.358).The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed,and the correlation between the pulsatility index for veins(PIV)and tissue Doppler Tei index ratios was the best(R2 of the isolated SUA group:0.865;R2 of the control group:0.627).CONCLUSION In the isolated SUA group,the atrial systolic peak velocity‘a’decreased,and this finding might be related to the changes in foetal cardiac functions.The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses.PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.展开更多
BACKGROUND Heart defects are the most common congenital malformations in fetuses.Fetal cardiac structure and function abnormalities lead to changes in ventricular volume.As ventricular volume is an important index for...BACKGROUND Heart defects are the most common congenital malformations in fetuses.Fetal cardiac structure and function abnormalities lead to changes in ventricular volume.As ventricular volume is an important index for evaluating fetal cardiovascular development,an effective and reliable method for measuring fetal ventricular volume and cardiac function is necessary for accurate ultrasonic diagnosis and effective clinical treatment.The new intelligent spatiotemporal image correlation(iSTIC)technology acquires high-resolution volumetric images.In this study,the iSTIC technique was used to measure right ventricular volume and to evaluate right ventricular systolic function to provide a more accurate and convenient evaluation of fetal heart function.AIM To investigate the value of iSTIC in evaluating right ventricular volume and systolic function in normal fetuses.METHODS Between October 2014 and September 2015,a total of 123 pregnant women received prenatal ultrasound examinations in our hospital.iSTIC technology was used to acquire the entire fetal cardiac volume with off-line analysis using QLAB software.Cardiac systolic and diastolic phases were defined by opening of the atrioventricular valve and the subsequent closure of the atrioventricular valve.The volumetric data of the two phases were measured by manual tracking and summation of multiple slices and recording of the right ventricular end-systolic volume and the right ventricular end-diastolic volume.The data were used to calculate the right stroke volume,the right cardiac output,and the right ejection fraction.The correlations of changes between the above-mentioned indices and gestational age were analyzed.The right ventricular volumes of 30 randomly selected cases were measured twice by the same sonographer,and the intraobserver agreement measurements were calculated.RESULTS Among the 123 normal fetuses,the mean right ventricular end-diastolic volume increased from 0.99±0.34 mL at 22 wk gestation to 3.69±0.36 mL at 35+6 wk gestation.The mean right ventricular end-systolic volume increased from 0.43±0.18 mL at 22 wk gestation to 1.36±0.22 mL at 35+6 wk gestation.The mean right stroke volume increased from 0.62±0.29 mL at 22 wk gestation to 2.33±0.18 mL at 35+6 wk gestation.The mean right cardiac output increased from 92.23±40.67 mL/min at 22 wk gestation to 335.83±32.75 mL/min at 35+6 wk gestation.Right ventricular end-diastolic volume,right ventricular end-systolic volume,right stroke volume,and right cardiac output all increased with gestational age and the correlations were linear(P<0.01).Right ejection fraction had no apparent correlation with gestational age(P>0.05).CONCLUSION Fetal right ventricular volume can be quantitatively measured using iSTIC technology with relative ease and high repeatability.iSTIC technology is expected to provide a new method for clinical evaluation of fetal cardiac function.展开更多
AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 ...AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.展开更多
目的应用右室自动功能成像(RV AFI)和四维自动右室定量技术(4D Auto RVQ)无创测量毛细血管前型肺动脉高压(PcPH)患者右室形态和功能参数,并分析其与有创血流动力学参数的相关性。方法选取我院经右心导管检查(RHC)确诊的PcPH患者48例(PcP...目的应用右室自动功能成像(RV AFI)和四维自动右室定量技术(4D Auto RVQ)无创测量毛细血管前型肺动脉高压(PcPH)患者右室形态和功能参数,并分析其与有创血流动力学参数的相关性。方法选取我院经右心导管检查(RHC)确诊的PcPH患者48例(PcPH组)和健康体检者30例(对照组),均行二维超声心动图检查获取右室壁厚度(RVWT)、右室内径(RVID)、三尖瓣环位移(TAPSE)、组织多普勒三尖瓣环收缩期峰值速度(S’);RV AFI检查获取右室整体应变(RVGLS)、右室游离壁应变(RVFWLS),以及右室游离壁基底段、中间段及心尖段应变(BS、MS、AS);4D Auto RVQ检查获取右室舒张末期和收缩末期容积(RVEDV、RVESV)、右室每搏量(RVSV)、右室舒张末期和收缩末期容积指数(RVEDVi、RVESVi)、右室每搏量指数(RVSVi)、面积变化率(FAC)、右室射血分数(RVEF),以及右室基底横径、中间横径及长径(RVDdbase、RVDdmid、RVLd),比较两组上述参数的差异。应用RHC测量血流动力学参数,包括平均右室压(mRVP)、平均肺动脉压(mPAP)、肺动脉楔压、肺血管阻力(PVR)、心输出量(CO)及心指数(CI)。分析PcPH患者各超声心动图参数与有创血流动力学参数的相关性。结果与对照组比较,PcPH组RVWT、RVID、RVEDV、RVESV、RVEDVi、RVESVi、RVDdbase、RVDdmid及RVLd均增大,TAPSE、S’、RVGLS、RVFWLS、BS、MS、AS、RVSV、RVSVi、FAC及RVEF均减小,差异均有统计学意义(均P<0.05)。相关性分析显示,PcPH患者二维超声心动图参数中,RVWT与mPAP、PVR均呈中等相关(r=0.520、0.486,均P<0.001);TAPSE与PVR呈中等相关(r=-0.424,P=0.003)。RV AFI参数中,RVGLS、RVFWLS与mPAP、PVR均呈强相关(r=0.705、0.614、0.678、0.608,均P<0.001)。4D Auto RVQ参数中,RVESV、FAC、RVEF与mPVP均呈强相关(r=0.604、-0.634、-0.647,均P<0.001);RVESV、RVESVi、RVSVi、FAC、RVEF与mPAP均呈强相关(r=0.784、0.749、-0.612、-0.747、-0.774,均P<0.001);RVSV、RVESVi、RVSVi、FAC、RVEF与PVR均呈强相关(r=-0.751、0.601、-0.775、-0.754、-0.834,均P<0.001);RVSV、RVSVi与CO均呈强相关(r=0.611、0.635,均P<0.001),与CI均呈中等相关(r=0.531、0.595,均P<0.001)。结论RV AFI、4D Auto RVQ参数与有创血流动力学参数具有良好的相关性,可无创评估PcPH患者右室形态和功能变化,具有一定的临床应用价值。展开更多
基金supported by the National Nature Science Fund(No.81300034)
文摘Background Early and accurate assessment of right ventricular changes in patients with Chronic obstructive pulmonary disease(COPD)is of great value,because these changes are important factors affecting the prognosis of patients with COPD. This study aimed to investigate the changes of right ventricular structure and function by electrocardiography in COPD patients,and to evaluate the correlations of pulmonary function,COPD assessment test(CAT)score with the changes. Methods According to the"ABCD"2016 Global initiative for chronic obstructive pulmonary disease(GOLD)update,stable COPD patients were divided into four groups:GOLD A group,GOLD B group,GOLD C group,and GOLD D group. There were 30 patients of each group enrolled from December 2016 to December 2017 in Guangdong General Hospital. During the same period,30 physical examination volunteers were enrolled as the healthy control group. Pulmonary function and echocardiography were performed in all subjects. All COPD patients completed CAT test. One-way ANOVA and SNK-q test were used to analyze the differences in parameters of right ventricular structure and function between different GOLD groups and healthy controls. Pearson correlation analysis was used to analyze the relation between CAT score,forced expiratory volume in one second(FEV1)and echocardiographic parameters. Results Compared with control group,right ventricular wall thickness(RVWT)was significantly thicker in patients of GOLD A,B and C groups(P<0.001),but not for GOLD D group. In sharp contrast,only in the patients of GOLD D group,right ventricular basal diameter(RV basal diameter)and right ventricular outflow tract(RVOT)(2.84±0.56 cm and 4.63±0.54 cm)were significantly longer than those in healthy controls and other GOLD groups(P<0.001).The patients of GOLD C and D groups had higher E/A ratio and E/e′ ratio compared with control group,GOLD A and B groups(P<0.001). But only in GOLD D group,the fractional area change(FAC)and tricuspid annular plane systolic excursion(TAPSE)were decreased significantly,compared with control group and other GOLD groups(P<0.001). The right ventricular index of myocardial performance(RIMP)in GOLD B,C and D groups was increased significantly compared with healthy control and GOLD A group(P<0.001). Moreover,correlation analysis showed that no correlations were found between FEV1 and all parameters of right ventricular structure and function,but CAT was positively correlated with RIMP(r=0.696,P=0.019). Conclusions Echocardiography could be a good assessment for right ventricular structure and function in COPD patients. Right ventricular wall thickening and diastolic dysfunction occur in the early stage of COPD,followed by right ventricular volume enlargement and systolic dysfunction.
文摘Objective Assessment of right ventricular function in patients with atrial septal defect(ASD)is difficult.The Doppler myocardial performance index(MPI)may provide a method of assessing function in these patients.The purposes of this study were to evaluate the right ventricular function and its changes in patients with ASD after transcatheter closure of ASD.Methods MPI,defined as the sum of isovolumic relaxation time and isovolumic contraction time derived by ejection time,was measured from tricuspid inflow and right ventricular outflow;Doppler velocity profiles recorded during routine echocardiography.Twenty nine patients(13 men,16 women;mean age 25.28±12.69,range 6 to 57 years)were diagnosed to secundum ASD[the stretched diameters of ASD were from 9 To 36(24.91±7.98)mm],and had a successfully placed Amplatzer septal occluder(ASO)(the sizes of ASO were from 11 to 40 mm);there were 81 sex-matched,age-matched healthy people(control group 41men,40 women;mean age 29.02±14.22,range 4 to 45 years).MPI was measured again on 3 days and 1 month after closure of ASD.Change in the study group was assessed and compared to the control subjects with structurally normal hearts.A complete 2-dimensional and Doppler echocardiographic examination was performed in all study groups.Results 1)The isovolumic relaxation and isovolumic contraction times[respectively(77.59±14.39)ms vs(60.93±12.94)ms,P<0.0001;(28.28±10.88)ms vs(23.64±9.01)ms,P=0.027]were prolonged,and ejection time[(260.65±21.86)ms vs(271.85±21.92)ms,P=0.033]was shortened in patients with ASD compared with that in control subjects,resulting in a marked increase in the MPI(0.40±0.07 vs 0.31±0.05,P<0.0001)from normal values;2)by Pearson's correlations,the MPI had no correlation with heart rate and blood pressure in control subjects and patients with ASD,but it correlated positively with age in patients with ASD;3)by Pearson's correlations,the MPI correlated positively with the diameter of ASD and pulmonary artery pressure;4)after transcatheter closure of ASD,the MPI decreased markedly.Conclusions 1)MPI is a conceptually new,simple,and reproducible Doppler index in patients with ASD;2)MPI is free from the effect of age,heart rate and blood pressure;(3)MPI appears to be relatively dependent on changes in the diameter of ASD and pulmonary artery pressure;4)the right ventricular function was improved after transcatheter closure of ASD.
文摘Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular （RV） function in atrial septal defect （ASD）. Methods Tissue Doppler images （TDI） of RV longitudinal and short axes were recorded from the apical 4-chamber view and the subcostal short-axis view in 18 normal controls, 28 children with ASD and 14 children after Amplazter closure of ASD respectively. Peak systolic velocities （ V）, peak systolic strain rates （SR）, peak systolic strains （S） at the basal segment, middle segment of RV lateral wall and the basal septum from the longitudinal axis, the middle segment of RV free waU from the short axis were quantitatively measured using QLAB^TM tissue velocity quantification software system respectively. Peak dp/ dt from the RV isovolumic contraction determined during the right cardiac catheterization in 28 ASD patients was used as the gold standard of RV contractility. Peak systolic indices were compared against max dp/dt by linear correlation, Results Peak systolic indices at the basal and middle segments of RV lateral wall from the longitudiual axis increased significantly in 28 ASD patients. Peak systolic indices at the basal septum also increased in patient group, but not significantly. Significant decreases in peak systolic indices at the basal and middle segments of RV lateral wall were observed after the Amplatzer closure in 14 ASD patients. There was no significant difference at the middle segment of RV free wall from the short axis between patient group and normal control. A strong correlation was found between max dp/dt and peak systolic indices at the basal and middle segments of RV lateral wal l （ P 〈 0. 05 ）. Conclusion Ultrasound-based strain rate imaging can assess quantitatively RVfunction in CHD. Peak systolic strains determined at the basal and middle segments of RV lateral wall are strong noninvasive indices of RV contractility.
文摘Objective Dilated cardiomyopathy(DCM) is generally considered to be accompanied by both left and right ventricular dysfunction,but most studies only analyze the left ventricular function. In this study,we evaluated the effect of arotinolol on right ventricular function in patients with DCM. Methods Right ventricular ejection fraction(RVEF) and right ventricular diameter(RVD) were measured by two-dimensional echocardiography(2-DE) in 33 DCM patients;RVEF measured by first-pass radionuclide angiography(FPRA) was compared with that by 2-DE. Results The treatment with arotinolol for one year resulted in a reduction in the right ventricular diameter(baseline,23.0 ± 8.3 mm vs after one-year treatment,20.7 ± 5.4 mm;P=0.004 ) and an associated increase in ejection fraction(baseline,36.9 ± 10.3% vs after one-year treatment,45.8 ± 9.6%;P < 0.001 ) ;there is a high correlation between the 2-DE method and radionuclide ventriculographic method. The correlation coefficient is 0.933(P<0.001) . Conclusion Arotinolol therapy could not only improve left ventricular function,but also improve right ventricular function in DCM patients.
基金Supported by National Key Basic Research Special Foundation of China(No.2012CB518600)。
文摘Objective:To investigate the effect of early intervention of Tongxinluo(通心络,TXL)on right ventricular function(RVF)of rats with pulmonary arterial hypertension(PAH)induced by monocrotaline(MCT).Methods:A total of 30 adult male Sprague-Dawley rats were assigned to 5 groups with complete random experiment design:Sham group(Sham),MCT group,TXL group,sildenafil(SIL)group and combination group(TXL+SIL),6 rats in each group.Rats were injected with 50 mg/kg MCT solution for inducing PAH model except for those in the sham group.From the day of modeling,rats of TXL,SIL and TXL+SIL groups were given TXL(1.2 g/kg),SIL(10 mg/kg)and combination solution(TXL:1.2 g/kg,SIL:10 mg/kg)respectively,and rats in Sham and MCT groups were given normal saline(5 m L/kg).The samples were collected and tested after 21 consecutive days of intragastric administration.Echocardiography was used to measure the related indices of RVF,including pulmonary arterial flow spectrum,pulmonary artery diameter(PAD),right ventricular wall thickness(RVWT),right ventricular diameter(RVD),tricuspidannular plane systolic excursion(TAPSE),right atrium transverse diameter(RAT),and inferior vena cava diameter(IVCD).Elastic Verhoeff-Van Gieson staining was adopted to measure the percentage of wall thickness(WT%)of pulmonary arteriols.Hematoxylin-eosin staining was used to measure the cross-sectional area(CSA)of right ventricular cardiomyocytes.Results:MCT-induced PAH rat model was successfully established.In MCT group the wall of pulmonary arterioles exhibited a prominent-increase thickness,PAD,RVWT,RVD,RAT,IVCD,WT%,right ventricular hypertrophy index(RVHI)as well as CSA of RV cardiomyocyte significantly increased(all P<0.01),and TAPSE markedly decreased(P<0.01).At the same time,TXL prominently improved all of the above indices(all P<0.01).In comparison with SIL,TXL significantly reduced RVD(P<0.05)and decreased CAS of RV cardiomyocytes(P<0.01),but TAPSE in SIL group was much larger than in TXL group(P<0.01).Moreover,TAPSE in TXL+SIL group was larger than that in TXL group(P<0.01),while the two groups performed equally well in terms of the other indices.Conclusion:Early intervention of TXL could inhibit pulmonary arterioles remodeling,and improve RVF by attenuating right ventricular hypertrophy,and TXL has a stronger effect on inhibiting right ventricular remodeling than SIL.
基金supported by the National Natural Science Foundation of China(82270057)the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University,China(XJTU1AF-CRF-20i9-010)Fundamental Project Plan in Shaanxi Province,China(2020JM-364).
文摘Right ventricular function is independently associated with poor clinical outcomes in patients with various cardiovascular diseases including pulmonary hypertension(PH).The complex geometry and mode of contractility means the right ventricle(RV)inlet and outlet are not in line;hence,2-dimensional echocardiography fails to accurately quantify RV volumes and function in such patients.Three-dimensional echocardiography(3DE)allows for reliable and reproducible quantification of RV volumes and function by overcoming these limitations of conventional echocardiography.This review focuses on the 3DE assessment of RV function in patients with PH and discusses the following points:(1)acquiring an RV data set for 3DE imaging,including details of all available 3DE systems and software utilized in daily practice;(2)the reliability and feasibility of RV remodeling measured with 3DE with different modalities in patients with PH;and(3)the prognostic value of 3DE-derived RV function in such patients.
文摘The optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function was assessed. RV “Full volume” images were acquired by RT3DE in 22 healthy subjects. RV end-diastolic volumes (RVEDV) and end-systolic volumes (RVESV) were outlined using apical biplane, 4-plane, 8-plane, 16-plane offline separately. RVSV and RVEF were calculated. Meanwhile tricuspid annual systolic excursion (TASE) was measured by M-mode echo. LVSV was outlined by 2-D echo according to the biplane Simpson's rule. The results showed: (1) There was a good correlation between RVSV measured from series planes and LVSV from 2-D echo (r=0.73; r=0.69; r=0.63; r=0.66, P<0.25—0.0025); (2) There were significant differences between RVEDV in biplane and those in 4-, 8-, 16-plane (P<0.001). There was also difference between RV volume in 4-plane and that in 8-plane (P<0.05), but there was no significant difference between RV volume in 8-plane and that in 16-plane (P>0.05); (3) Inter-observers and intro-observers variability analysis showed that there were close agreements and relations for RV volumes (r=0.986, P<0.001; r=0.93, P<0.001); (4) There was a significantly positive correlation of TASE to RVSV and RVEF from RT3DE (r=0.83; r=0.90). So RV volume measures with RT3DE are rapid, accurate and reproducible. In view of RV's complex shape, apical 8-plane method is better in clinical use. It may allow early detection of RV systolic function.
文摘Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot(TOF)by 2-dimensional ultrasound speckle tracking imaging(STI).Thirty-eight patients with TOF were enrolled in this study and divided into child group(n=25)and adult group(n=13)according to age.Thirty-eight age-and sex-matched normal subjects were selected as c...
文摘Summary: To study reliability and reliable indices of quantitative assessment of right ventricular systolic function by time-intensity curve (TIC) with right ventricular contrast, 5 % sonicated human albumin was injected intravenously at a does of 0.08 ml/kg into 10 dogs at baseline status and cardiac insufficiency. Apical four-chamber view was observed for washin and washout of contrast agent from right ventricle. The parameters of TIC were obtained by curve fitting. The differences of parameters were analyzed in different states of cardiac functions. Among the parameters derived from TIC, the time constant (k) was decreased significantly with decline of cardiac function (P<0.001). But half-time of decent of peak intensity (HT) and mean-transit-time (MTT) of washout were increased significantly (P<0.001). The k was strongly related to cardiac output of right ventricle (CO) and ejection fraction (EF) of left ventricle and fractional shortening (FS) of left ventricle. Right ventricular systolic function could be assessed reliably by the parameters derived from TIC with right ventricular contrast echocardiography. The k, HT and MTT are reliable indices for quantitative assessment of right ventricular systolic function.
文摘BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart,affecting foetal circulation.The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus(DV).AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls.The DV flow velocities and velocity ratios were measured.The early passive/late active(E/A)ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.RESULTS During the third trimester,the isolated SUA group showed a lower‘a’-wave peak velocity in the DV than the control group(P<0.05).The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best(R^2of the isolated SUA group:0.520;R2 of the control group:0.358).The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed,and the correlation between the pulsatility index for veins(PIV)and tissue Doppler Tei index ratios was the best(R2 of the isolated SUA group:0.865;R2 of the control group:0.627).CONCLUSION In the isolated SUA group,the atrial systolic peak velocity‘a’decreased,and this finding might be related to the changes in foetal cardiac functions.The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses.PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.
文摘BACKGROUND Heart defects are the most common congenital malformations in fetuses.Fetal cardiac structure and function abnormalities lead to changes in ventricular volume.As ventricular volume is an important index for evaluating fetal cardiovascular development,an effective and reliable method for measuring fetal ventricular volume and cardiac function is necessary for accurate ultrasonic diagnosis and effective clinical treatment.The new intelligent spatiotemporal image correlation(iSTIC)technology acquires high-resolution volumetric images.In this study,the iSTIC technique was used to measure right ventricular volume and to evaluate right ventricular systolic function to provide a more accurate and convenient evaluation of fetal heart function.AIM To investigate the value of iSTIC in evaluating right ventricular volume and systolic function in normal fetuses.METHODS Between October 2014 and September 2015,a total of 123 pregnant women received prenatal ultrasound examinations in our hospital.iSTIC technology was used to acquire the entire fetal cardiac volume with off-line analysis using QLAB software.Cardiac systolic and diastolic phases were defined by opening of the atrioventricular valve and the subsequent closure of the atrioventricular valve.The volumetric data of the two phases were measured by manual tracking and summation of multiple slices and recording of the right ventricular end-systolic volume and the right ventricular end-diastolic volume.The data were used to calculate the right stroke volume,the right cardiac output,and the right ejection fraction.The correlations of changes between the above-mentioned indices and gestational age were analyzed.The right ventricular volumes of 30 randomly selected cases were measured twice by the same sonographer,and the intraobserver agreement measurements were calculated.RESULTS Among the 123 normal fetuses,the mean right ventricular end-diastolic volume increased from 0.99±0.34 mL at 22 wk gestation to 3.69±0.36 mL at 35+6 wk gestation.The mean right ventricular end-systolic volume increased from 0.43±0.18 mL at 22 wk gestation to 1.36±0.22 mL at 35+6 wk gestation.The mean right stroke volume increased from 0.62±0.29 mL at 22 wk gestation to 2.33±0.18 mL at 35+6 wk gestation.The mean right cardiac output increased from 92.23±40.67 mL/min at 22 wk gestation to 335.83±32.75 mL/min at 35+6 wk gestation.Right ventricular end-diastolic volume,right ventricular end-systolic volume,right stroke volume,and right cardiac output all increased with gestational age and the correlations were linear(P<0.01).Right ejection fraction had no apparent correlation with gestational age(P>0.05).CONCLUSION Fetal right ventricular volume can be quantitatively measured using iSTIC technology with relative ease and high repeatability.iSTIC technology is expected to provide a new method for clinical evaluation of fetal cardiac function.
文摘AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.
文摘目的应用右室自动功能成像(RV AFI)和四维自动右室定量技术(4D Auto RVQ)无创测量毛细血管前型肺动脉高压(PcPH)患者右室形态和功能参数,并分析其与有创血流动力学参数的相关性。方法选取我院经右心导管检查(RHC)确诊的PcPH患者48例(PcPH组)和健康体检者30例(对照组),均行二维超声心动图检查获取右室壁厚度(RVWT)、右室内径(RVID)、三尖瓣环位移(TAPSE)、组织多普勒三尖瓣环收缩期峰值速度(S’);RV AFI检查获取右室整体应变(RVGLS)、右室游离壁应变(RVFWLS),以及右室游离壁基底段、中间段及心尖段应变(BS、MS、AS);4D Auto RVQ检查获取右室舒张末期和收缩末期容积(RVEDV、RVESV)、右室每搏量(RVSV)、右室舒张末期和收缩末期容积指数(RVEDVi、RVESVi)、右室每搏量指数(RVSVi)、面积变化率(FAC)、右室射血分数(RVEF),以及右室基底横径、中间横径及长径(RVDdbase、RVDdmid、RVLd),比较两组上述参数的差异。应用RHC测量血流动力学参数,包括平均右室压(mRVP)、平均肺动脉压(mPAP)、肺动脉楔压、肺血管阻力(PVR)、心输出量(CO)及心指数(CI)。分析PcPH患者各超声心动图参数与有创血流动力学参数的相关性。结果与对照组比较,PcPH组RVWT、RVID、RVEDV、RVESV、RVEDVi、RVESVi、RVDdbase、RVDdmid及RVLd均增大,TAPSE、S’、RVGLS、RVFWLS、BS、MS、AS、RVSV、RVSVi、FAC及RVEF均减小,差异均有统计学意义(均P<0.05)。相关性分析显示,PcPH患者二维超声心动图参数中,RVWT与mPAP、PVR均呈中等相关(r=0.520、0.486,均P<0.001);TAPSE与PVR呈中等相关(r=-0.424,P=0.003)。RV AFI参数中,RVGLS、RVFWLS与mPAP、PVR均呈强相关(r=0.705、0.614、0.678、0.608,均P<0.001)。4D Auto RVQ参数中,RVESV、FAC、RVEF与mPVP均呈强相关(r=0.604、-0.634、-0.647,均P<0.001);RVESV、RVESVi、RVSVi、FAC、RVEF与mPAP均呈强相关(r=0.784、0.749、-0.612、-0.747、-0.774,均P<0.001);RVSV、RVESVi、RVSVi、FAC、RVEF与PVR均呈强相关(r=-0.751、0.601、-0.775、-0.754、-0.834,均P<0.001);RVSV、RVSVi与CO均呈强相关(r=0.611、0.635,均P<0.001),与CI均呈中等相关(r=0.531、0.595,均P<0.001)。结论RV AFI、4D Auto RVQ参数与有创血流动力学参数具有良好的相关性,可无创评估PcPH患者右室形态和功能变化,具有一定的临床应用价值。
