| Part I. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in Normal Adults Using Real-time Three-Dimensional EchocardiographyObjective:To evaluate the value of real-time three-dimensional echocardiography (RT3DE) in assessment of right ventricular (RV) global and regional volume and systolic function, and to explore the characteristics of RT3DE parameters in normal adults.Methods:RT3DE images were acquired from53normal adults for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including RV diameters and areas were calculated and recorded.Results:RT3DE images were successfully acquired and analyzed in51(96%) normal adults. Higher RV global and regional (body and outflow) EDV and SV, higher global and regional ESV and lower inflow EF were found in the male group when compared with the female group (all P<0.05).There was no significant difference in dyssynchrony parameters between the male and female subjects. It was found that EDV and SV in the inflow compartment were the highest in the three compartments of the right ventricle (all P<0.05), and the difference of regional EF were ordered from larger to smaller as inflow>outflow>body (all P<0.05). The differences among global and regional Tmsv and Tmsv%were not significant. RV global EDV was positively correlated with RV end-diastolic diameters and area (all P<0.05). RV global ESV was positively correlated with RV end-systolic diameters and area (all P<0.05). RV global SV was positively correlated with RV stroke volume. Intra-and inter-variability of RT3DE parameters was relatively low。 Conclusions:In normal adults, there were distinct characters of regional volume and systolic function in the three compartments of the right ventricle, with certain differences between males and females. Evaluation of RV global and regional volume and systolic function using RT3DE method was found to be of relatively high accuracy and reproducibility. Part Ⅱ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in Pathological Conditions Using Real-time Three-Dimensional EchocardiographySection Ⅰ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with atrial septal defect Using Real-time Three-Dimensional EchocardiographyObjective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with secondum atrial septal defect (ASD) using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.Methods:RT3DE images were acquired from22patients with secundum ASD and22age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVRe) and maximum diameter of ASD (ASD-D) were calculated and recorded.Results:RT3DE images were successfully acquired analyzed in all the subjects. RV global and regional EDV、 ESV and SV were larger (all P<0.001) and EF was lower (all P<0.05) in the ASD group than in the controls. There were no significant differences in Tmsv、 Tmsv%and RV dyssynchrony parameters between the two groups. In the patients group, EDV in the outflow compartment was lower than that in the inflow compartment (P<0.05); ESV in the outflow compartment was the lowest among the three compartments (P<0.05); SV and EF in the inflow compartment were the highest among the three compartments (P<0.05); RV global EF, similar with regional EF in the inflow and outflow compartments, was higher than that in the body compartment (P<0.05). In patients with ASD, RV global and regional EDV, ESV and SV in the inflow compartment were positively correlated with ASD-D and PASP (r=0.541-0.704, all P<0.05); RV global and regional SV in all the three compartments were positively correlated with ASD-D (r=0.463-0.681, all P<0.05); RV global EF was negatively correlated with PVRe (r=-0.477. P<0.05).Conclusions:In patients with ASD, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global and regional volumes were positively correlated with RV pre-load and RV global EF was negatively correlated with RV after-load. Section Ⅱ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with valvular heart disease Using Real-time Three-Dimensional EchocardiographyObjective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with valvular heart disease using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.Methods:RT3DE images were acquired from23patients with valvular heart disease and23age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVRe) were calculated and recorded.Results:RT3DE images were successfully acquired analyzed in all the subjects. RV global and regional EDV, ESV and SV were larger (all P<0.05) and EF was lower (all P<0.05) in patients with valvular heart disease than in the controls. RV dyssynchrony parameters including Tmsv%-SD, Tmsv-SD, Tmsv%-dif and Tmsv-dif were higher in patients with valvular heart disease than in the controls (all P<0.05). In patients group, EDV and SV in the inflow compartment was the highest among three compartments (P<0.05); ESV in the inflow compartment was higher than that in the outflow compartment (P<0.05); RV global EF, similar with regional EF in the inflow and outflow compartments, was higher than that in the body compartment (P<0.05). In patients with valvular heart diseases, there was no significant correlation between RT3DE parameters and PASP; RV global EF and EF in the inflow compartment were negatively correlated with PVRe (r=-0.686,-0.675, both P<0.001).Conclusions:In patients with valvular heart disease, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global EF and regional EF in the inflow compartment were negatively correlated with RV after-load. Section III. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in patients with pulmonary arterial hypertension Using Real-time Three-Dimensional EchocardiographyObjective:To evaluate right ventricular (RV) global and regional volume and systolic function in patients with pulmonary arterial hypertension (PAH) using real-time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters derived from RT3DE and parameters measured by right heart catheterization (RHC).Methods:RT3DE images were acquired from25patients with PAH and25age-and gender-matched normal normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. RHC was performed in17patients to obtain pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR).Results:RT3DE images were successfully acquired analyzed in24(96%) patients with PAH. RV global and regional EDV, ESV and SV were larger (all P<0.001) and EF was lower (all P<0.001) in patients with PAH than in the controls. RV dyssynchrony parameters including Tmsv%-SD, Tmsv-SD, Tmsv%-dif and Tmsv-dif were higher in patients with PAH than in the controls (all P<0.05). In the patients group, EDV in the inflow compartment was higher than in the outflow compartment (P<0.05); ESV in the inflow and body compartments were higher than in the outflow compartment (P<0.05); SV in the inflow compartment was the highest among the three compartments (P<0.05); EF in the body compartment was the lowest among the three compartments (P<0.05). In patients with PAH, RV global EF and regional EF in the inflow compartment were negatively correlated with PASP (r=-0.486、-0.471, both P<0.05) and PVR measured by RHC (r=-0.732,-0.592, both P<0.001), and with PVR estimated by echocardiography (r=-0.644,-0.510. both P<0.05). Conclusions:In patients with PAH, RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global and regional EF in the inflow compartment were negatively correlated with RV after-load. Part Ⅲ. Evaluation of Right Ventricular Global and Regional Volume and Systolic Function in healthy Beagle Dogs Using Real-time Three-Dimensional EchocardiographyObjective:To evaluate the value of real-time three-dimensional echocardiography (RT3DE) in assessment of right ventricular (RV) global and regional volume and systolic function, and to explore the characteristics of RT3DE parameters in healthy canine model.Methods:RT3DE images were acquired from10healthy Beagle dogs for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv%) in three RV compartments. Conventional echocardiographic parameters including RV diameters and left ventricular stroke volume were calculated and recorded.Results:RT3DE images were successfully acquired and analyzed in8(80%) Beagles. It was found that EDV, ESV and SV in the inflow compartment were the highest in the three compartments of the right ventricle of healthy Beagle dogs (all P<0.05), and there was no significant differences between EDV ESV and SV in the body and outflow compartment. The differences among global and regional EF, Tmsv and Tmsv%were not significant. RV global EDV was positively correlated with RV end-diastolic diameters and area (all P<0.05). RV global ESV was positively correlated with RV end-systolic diameters and area (all P<0.05). There was no significant difference between RV global SV and left ventricular stroke volume. RV global EF and EF in the inflow compartment were positively correlated with RV fractional area change (r=0.656,0.757, both P<0.05). Intra-observer and test-retest variability of RT3DE parameters was relatively low。Conclusions:In healthy Beagle dogs, there were distinct characters of regional volume and systolic function in the three compartments of the right ventricle; evaluation of RV global and regional volume and systolic function using RT3DE method was found to be of relatively high accuracy and reproducibility, and the present research provide a basis for further study of the changes in the right ventricle in canine models. |
PDF Full Text Request