Comparative Study Of The New Technology Of Four-dimensional Automatic Right Ventricular Quantitative Analysis And Traditional Echocardiography In Evaluating Right Ventricular Systolic Function In Patients With Pulmonary Hypertensio

Background:Tricuspid annular plane systolic excursion(TAPSE),systolic annular velocity(S’),and fractional area change(FAC)measured by echocardiography are the primary parameters used to assess right ventricular(RV)systolic function in patients with pulmonary hypertension(PH).However,with the advancement of ultrasound technology,recent studies have shown that four-dimensional echocardiography has significant value in analyzing both the morphology and function of the PH RV.Therefore,this study aimed to compare the performance of four-dimensional automatic right ventricular quantification(4D auto-RVQ)and traditional methods in evaluating RV systolic function in PH patients using RV cardiac index(CI)measured by right heart catheterization as the reference standard.Methods:Between September 2017 and December 2018,a single-center prospective study was conducted to recruit PH patients admitted to Fuwai Hospital of the Chinese Academy of Medical Sciences.Within 24 hours of admission,all patients underwent both right heart catheterization and comprehensive echocardiography examinations administered by welltrained technicians who were blind to the clinical data.The RV indices measured by 4D auto-RVQ included:end-diastolic volume(EDV),end-systolic volume(ESV),stroke volume(SV),ejection fraction(EF),longitudinal strain(LS)of interventricular septum and free wall,RV diameters(D),TAPSE,and FAC.By means of statistical analysis,this study aimed to compare the ability of traditional 2D parameters versus RV parameters measured by 4D auto-RVQ in evaluating RV systolic function in PH patients.Results:Based on the inclusion and exclusion criteria,60 patients with PH were screened for this study,of whom 18 had high-quality four-dimensional images.If all patients were included in the statistical analysis,weak correlations(r<0.4)were found between each of echocardiographic parameters and RV-CI.Only RV-EDV and RV-ESV showed significant differences(P<0.05)between the group with reduced RV systolic function(CI<2.5 L/(min·m2))and the normal RV systolic function group(CI≥2.5 L/(min·m2)),and they were the best predictors of RV-CI<2.5 L/(min·m2))(P<0.05).However,when only patients with high-quality images were considered,significant correlations(r>0.4)were found between RV-EDV,RV-ESV,RV-EF,RVLS(free wall),RVD(mid),RV-FAC(4D),and RVCI.RV-EDV,RV-ESV,RVLS(free wall),RVD(basal),RVD(mid),and RV-FAC(4D)showed significant differences(P<0.05)between the reduced RV systolic function group and the normal RV systolic function group.Furthermore,RV-EDV,RV-ESV,RVD(basal),RVD(mid),and RV-FAC(4D)were effective predictors of RV-CI<2.5 L/(min·m2)(P<0.05).Conclusion:As a novel technique,4D auto-RVQ could measure more RV parameters,and offers greater advantages over traditional two-dimensional echocardiography in assessing RV systolic function in PH patients.However,the above conclusion needs further verification in future studies.