Evaluation Of Right Ventricular Systolic Function And Left Ventricular Systolic Function In Patients With Pulmonary Embolism By Single Cardiac Cycle Real-time Three Dimensional Echocardiography

Objective: To assess right ventricular systolic function in patients withdifferent areas of pulmonary embolism by using single cardiac cyclereal-time three dimensional echocardiography (sRT-3DE) and analyzewhether left ventricular systolic function was impaired or not in patients withdifferent areas of pulmonary embolism.Methods:1Forty patients with pulmonary embolism were divided into group A andgroup B according to different areas and another20healthy volunteers servedas control group. Forty patients with pulmonary embolism were selectedexclusive of chronic obstructive pulmonary disease, bronchial asthma,pulmonary valve stenosis and other cardiovascular diseases. The healthyvolunteers had no related medical history of hypertension, chronic lungdisease or other cardiovascular diseases; physical examination, chestradiography, laboratory tests, ECG and ultrasound echocardiography showedno abnormality. Group A enrolled20cases of massive pulmonary embolismwhile group B involved20cases of non-massive pulmonary embolism.2SIEMENS Company's ultrasound diagnostic apparatus ACUSON SC2000was employed, with a probe of4Z1c, probe frequency of1～4MHz,gray-scale three-dimensional fan angle of90°×90°, depth of16cm,volumetric frame rate>20volume/s, color Doppler three-dimensional fanangle of40°×40°, a depth of16cm and plot frame rate>20volume/s aswell as the LVA, the RVA volume automatic analysis software.3All subjects held left lateral position, kept a quiet breathe and wereconnected to chest lead ECG, to record patients' gender, age, height, weight, blood pressure and heart rate. First, the two-dimensional image acquisitionand parameters measurement were completed by using conventionaltarn-thoracic echocardiography; then the4D mode was activated, the depthwas adjusted appropriately and the probe was placed in the apex to take theapical four-chamber view; the subjects were required to keep quiet breathing,and acoustic collection was used to finish image acquisition and cardiac cycleswith better image quality were kept;"Dynamic Storage" function key wasthen activated to collect a3D full-volume images of the cardiac cycle, whichwas stored in hardware for off-line analysis.4Parameters measurement and image analysis:4.1Parameters of the conventional two-dimensional echocardiography:right ventricular diameter (RVD), diameter ratio of right ventricle to leftventricle (RV/LV), the right ventricular wall thickness (RVAW) and diameterof main pulmonary artery (PAD).4.2According to the Continuous Doppler tricuspid regurgitation speed,pulmonary artery systolic pressure (PASP) was estimated.4.3Parameter measurement of three-dimensional volume of right ventricle:The image was extracted from ACUSON SC2000workstation and putinto the right ventricular volume automatic analysis software (RVA), followingthe Action menu:(1):Set the center of the basal segment of the left ventricle,the right ventricle and left ventricular apex,(2):Set end-systolic and enddiastolic images;(3):Manually record total apical four-chamber view, mitralvalve level, the left ventricular short axis view as well as right ventricularsystolic and end-diastolic endocardial border;(4): Cut out the right ventricularoutflow tract cross-section automatically by Software, and manually recordright ventricular end-systolic and end-diastolic endocardial border;(5): basedon the manually recorded endocardial border in (3) and (4), the softwareautomatically record endocardial border of the right ventricular cavitythroughout the cardiac cycle;(6): Evaluation of the results in (5) by softwaremight be unsatisfactory, which then could be modified manually; aftermodification, the software automatically draw3D volume diagram, time- volume curves and related parameters of the right ventricle, such as rightventricular end-diastolic volume(EDVRV), right ventricular end-systolicvolume(ESVRV), right ventricular stroke volume (SVRV) and right ventricularejection fraction(RVEF).4.4Parameter measurement of three-dimensional volume of left ventricle:The image was extracted from ACUSON SC2000workstation and putinto the left ventricular volume automatic analysis software (LVA); based onthe pre-set, software automatically identified the end-systolic and end-diastolicvolume images, and these images were identified along the endocardium; ifautomatic identification was not satisfactory, identification mark of theendocardium could be adjusted manually, and then the software wouldautomatically draw the following parameters: Obtain the following parameters:left ventricular end-diastolic volume (EDVLV), left ventricular end-systolicvolume(ESVLV), left ventricular stroke volume(SVLV) and left ventricularejection fraction (LVEF).Results:1Comparison of general clinical parameters between normal control and PEgroupsGender, age and body surface among the groups had no statisticallysignificant difference. group A, B. Compared with group A and group B,resting heart rate in the control group had statistically significant difference;compared with group B, systolic and diastolic blood pressure in the controlgroup had no statistically significant difference while compared with group Athere was statistically significant difference in control group; systolic anddiastolic blood pressure in group A and group B had statistically significantdifferences.2Comparison of conventional ultrasonic measurement parameters in groupsRVAW in groups had no statistically significant difference; Comparedwith the control group, PAD in group B had no statistically significantdifference, but the PAD was increased compared with group A,which hadstatistically significant difference; compared group A and group B, there was statistically significant difference; compared with control group, RVD and(RV/LV) had statistically significant difference in group A and group B; RVDand RV/LV were increased in group A and group B, and patients withpulmonary embolism in group A and group B showed statistically significantdifference.3Comparison of PASP between normal control and PE groupCompared with control group, PASP in group A and group B wasincreased, which had statistically significant difference.4Comparison of right ventricular systolic function parameters in groups4.1Compared with control group, IEDVRV, IESVRVin group A and group Bincreased, which had statistically significant difference; between the group Aand group B there was statistically significant difference; compared withcontrol group, ISVRVand RVEF decreased, which had statistically significantdifference; between the group A and group B there was statistically significantdifference.4.2Compared with control group, the time-volume curve showed a decreasingtrend in group A and group B. RT-3DE right ventricular volume curvedecreased in group A and group B compared with the control group; peaksystolic moved backward, and there was statistically significant difference inpatients with pulmonary embolism in group A.5Comparison of left ventricular systolic function parameters in groupsCompared with control group, LVEF of group B had no statistically significantdifference, but IEDVLV, IESVLVand ISVLVafter correction were decreased,which had statistically significant difference. Compared with group A, IEDVLV,IESVLV, ISVLVand LVEF after correction had statistically significantdifference; between group A and group B there was statistically significantdifference.Conclusion: Right ventricular systolic function in patients withpulmonary embolism reduced, and sRT-3DE could be used to quantitativelyand accurately assess right ventricular systolic function in patients withpulmonary embolism; left ventricular systolic function in patients with massive pulmonary embolism reduced, which suggested impaired leftventricular function in patients with massive pulmonary embolism.