Assessment Of Right Ventricular Systolic Function In Patients With Moderate And Severe Pulmonary Hypertension By Real-time 3D Echocardiography

ObjectiveQuantitative measurement of right ventricular volume and ejection fraction in patients with moderate and severe pulmonary hypertension(PAH)by real time three-dimensional echocardiography(RT-3DE),and compared with conventional echocardiographic parameters,Objective to investigate the clinical value of right ventricular systolic function in patients with moderate and severe PAH,and to find a reliable index for evaluating the right ventricular systolic function in patients with different degrees of PAH by conventional echocardiographic parameters.Methods25 patients with moderate PAH(group Ⅱ,50mmHg<PASP≤70mmHg),25 patients with severe PAH(group Ⅲ,PASP>70mmHg)and 30 control subjects(group Ⅰ)were involved.Generally:Measure and record the age,height,weight,heart rate and so on of each subject.Conventional echocardiographic parameters:Use M5 S probe to measure Right atrial left and right diameter(RA-D1),upper and lower diameter(RA-D2),Right ventricular basal diameter(RV-D),Right ventricular free wall thickness(RV-FW),the maximum regurgitant velocity(V)of tricuspid valve,Pulmonary artery systolic pressure(PASP),Right ventricular fractional area change(RVFAC),Tricuspid annular systolic peak velocity(S’),Right ventricular myocardial performance index(RIMP)and Tricuspid annular systolic displacement(TAPSE)separately.Three dimensional image acquisition and data analysis : Switch to the 4V probe,continuous acquisition of 3 cycles of dynamic three dimensional image of right ventricular and stored.Import images into Echo PAC workstation storage,use "4D Auto RVQ" program,finally got Right ventricular systolic volume(RVESV),Right ventricular end diastolic volume(RVEDV),Right ventricular stroke volume(RVSV)and Right ventricular ejection fraction(RVEF).To evaluate the reproducibility of right ventricular systolic function by RT-3DE technique,and analyze the differents of all the parameters among three groups,analyze the correlation between all the parameters and PASP,the correlation between RVEF and S’,RIMP,TAPSE,RVFAC respectively.Results1.Comparison of general data among groups:There was no significant differences in age,heart rate,body weight and height between the groups(all P>0.05).2.Comparison of right ventricular structures among groups:There were significant differences in RA-D1 and RA-D2 among the groups(all P<0.01);RV-D was no significant difference in group Ⅰ and group Ⅱ(P=0.201),there were statistically significant differences in groupⅠand group Ⅲ,groupⅡand groupⅢ,(all P<0.01);RV-FW was no statistically difference in groupⅡandⅢ(P=0.065),there were statistically significant differences in groupⅠand groupⅡ,groupⅠand group Ⅲ(all P< 0.01).3.Comparison of RT-3DE parameters among groups: There were significant differences in RVEDV and RVESV among the groups(all P<0.01);RVEF were statistically significant differences in groupⅠand groupⅡ,groupⅠand groupⅢ(all P<0.01),there was no statistically significant difference in groupⅡand groupⅢ(P>0.02);RVSV was statistical significance in groupⅠand groupⅢ(P< 0.01),there were no significant difference between the groupⅠand groupⅡ,group Ⅱand groupⅢ(all P>0.02).4.Comparison of conventional echocardiographic parameters among groups: There were significant differences in TAPSE and RVFAC among the groups(all P<0.01),RIMP were statistically significant differences in groupⅠand groupⅡ,groupⅠand groupⅢ(all P<0.01),there was no statistically significant difference in group Ⅱand groupⅢ(P>0.02),S’ was significant differences in groupⅠand groupⅢ(P<0.01),and there were no significant difference in groupⅠand groupⅡ,groupⅡand groupⅢ(all P>0.02).5.Correlation analysis:The correlation coefficients of RVEDV,RVESV,RVEF,RIMP,S’,TAPSE,RVFAC and PASP were 0.744,0.822,-0.861,0.602,-0.334,-0.621,-0.725respectively(all P<0.01),The correlation coefficients of RVEF and RIMP,S’,TAPSE and RVFAC were-0.707,0.402,0.574,0.763(all P<0.01),The correlation coefficients of RVEF and RIMP,S’,TAPSE,RVFAC in group Ⅰ were-0.68,0.575,0.728,0.787(all P<0.01),The correlation coefficients of RVEF and above parameters of groupⅡwere-0.679,0.39,0.672,0.631(all P<0.01),and the correlation coefficients of RVEF and above parameters in groupⅢwere-0.559,0.369,0.661,0.744(all P<0.01).6.Repetitive study:The mean RVEF difference observed by the same observer was(0.22±2.1)%,The intraclass correlation coefficient was 0.897,The Blant-Altman chart also shows the trend of the consistency of repeated measurements with the mean RVEF.Conclusion1.With the increase of PASP,the right ventricular volume increased gradually while the systolic function decreased2.RT-3DE technology can be used to quantitatively evaluate the right ventricular volume and ejection fraction in patients with moderate and severe PAH,it can provide important reference value for clinical.3.The correlation between RVEF and conventional echocardiographic parameters from high to low was RVFAC,RIMP,TAPSE,S’,when evaluating right ventricular systolic function in normal subjects and in patients with moderate and severe PAH,the most reliable conventional echocardiographic parameters were RVFAC,RIMP,RVFAC respectively.