The Study Of The Applying Value To Evaluate The Right Ventricular Function Of The Heart Failure Patients By Echocardiography

Objective:The heart failure is the final end-result and the overriding death cause of the majority of the heart and lung disease. Some study results show that the prognosis of the HF is unfavourable. The 60% death cause of the HF patients was the sudden death, the sudden death mostly occurred in the light heart failure patients, the sudden death was closely related with the heart function. How to do the qualitation and quantitation evaluation of the heart function precisely is the important topic which was constantly concerned by the internal and foreign medical scientists.The right heart ventricle is one part of the whole heart function, the function of the right heart ventricle is not studied sufficiently.The systolic and diastolic function of the left heart ventricle was the evaluation standard during the clinical heart function evaluation and the skill examination.In the recent years along with the improvement of the research technology,it was emphasized that the right ventricle made a great contribution to maintain the heart circulation, the quantitation evaluation of the right ventricle function also played an important role to evaluate the severe degree and the prognosis of the HF patients.Along with the high-technology rapid development of the computer information technology and electronic technology, now the ultrasound technology is the fastest development of the imaging technology. The intelligent acoustic quantification (AQi) was based on the backscatter radiation , AQi can recognize the endocardium automatically, identify the tissue and blood or the noise sound at the real time, distinguish the tissue from the blood precisely. The right ventricle myocardium performance index (RVMPI) was the ration of the ventricle isometry activity time over the ventricular ejection time during the cardiac cycle, it was the new Doppler echocardiography index to synthetically evaluate the heart systolic and diastolic function.The tissue doppler imaging(TDI) was the supersonic sounding technology of the myocardium activity by displaying the low frequent Doppler frequency shift produced by the myocardium activity with the colourcoding or frequency spectrum at the real time. The ICK was the intelligent software invented by scientist 5#[n5^ of Japan the software can quantitate automatically the each segment endocardium bias CK-DI value(one percentage ratio :the diastolic area of the local myocardium during the 30% time of the diastolic nonage over the changing area during the whole diastolic time). In this study AQk RVMPL TDI> tricuspid valve> pulmonary artery^ left hepatic vein blood flow doppler technology-, uniplanar area-macro diameter method and ICK software were used to evaluate the right ventricle systolic and diastolic function respectively, from different angles and by using different methods to study the right ventricle function , so that the clinical heart function can be evaluated reasonably for the treatment can be obtained.Methods and resultspart one: to study the shape. function and flow kinesics of the right ventricle of the HF patients by AQi and blood flow Doppler technologymethods: 46 cases of the HF patients(grade III—IV) and 50 healthy people were checked by AQi % RVMPL TDI-. tricuspid valve > pulmonary artery > left hepatic vein blood flow doppler technology. uniplanar area-macro diameter method and ICK software respectivel, the observation index including: the end diastolic volume of the right ventricle (RVEDV): 1 . the end systolic volume of the right ventricle (RVESV) > ejection fraction of the right ventricleC RVEF)-. peak ejection rate of the right ventricle( RVPER ) > peak rapid filling rate of the right venricle ( RVPRFR) <> atrial filling fraction of the right antrum (RVAFF);2> RVMPI;3> the E peak > A peak> E/A ration. DT value of the tricuspid valve;Left hepatic veins inner diameter (LHVDX aVm> sVhk dVm flow rate;the value of PV peak. AT. RPEP. RVET. RPEP/RVET ration;4. ejection fraction of the right ventricle and the volume index of the right ventricle (RVEF. RVEDVI. RVESVI), all the data were analyzed by using the statistic softwareresults: Compared with the control :1. the AQi results of the HF patients showed that the right ventricle volume, the changing ratio of the changing curve of the volume over the time were small, wave amplitude was flat, the fluctuation degree became small. RVEDV. RVESV. RVPRFR and RVAFF were increased, RVEF and RVPER becamesmall (P<0.01, P<0.05);2> RVEDVL RVESVI and RVEF were decreased( P<0.05);3> RVMPI of the HF patients were more higher than the normal control, was 042±0.05, 0.32±0.05 (P<0.05);4^ the E peak ^ E/A ratio of 12 cases were decreased significantly and lower than 1, A peak was increased significantly, the DT value was prolonged significantly.The E peak^ A peak and E/A ratio of 11 cases were normal, the DT value was prolonged significantly;the E peak of 23 cases were increased significantly, E/A ratio were lager than 2.the DT value was short, the PV was increased -. RPEP was prolonged ^ RVET was short ^ RPEP/RVET was increased -. the AT time was short, the flow rate of aVnu sVnu dVm was decreased. (p<0.05, p<0.01);5> RVEDVI> RVESVI and RVEF were decreased(P<0.05).5> The parameters of different groups had good associativity.part two: to compare the TDI technology with the right ventricle floating catheter technology applying on evaluation of the right ventricular diastolic and systolic function of the HF patientsmethods: 16 HF patients whose heart function was gradelll—IV,15 HF patients whose heart function was grade II (including grade II) and 20 cases of healthy people were checked by the TDI technology and the right ventricle floating catheter technology respectivel. Analyzing the each parameter and compare their associativity.methods: In the three groups the every TDI parameter of the right ventricular free wall fundament segment was higher than the parameter index of the interventricular septum fundament segment, there was a significant difference between every parameter of the free wall and interventricular septum ( P<0.05 ). Compared with the normal control, Sm> Em and Em/Am ratio of the HF groups were decreased at different level, Am was increased at different level, there was a significant difference between the two groups (P<0.01, P<0.05). In the HF group whose heart function was grade III—IV,Compared the parameter of TDI with the floating catheter technology, there was difference between the two groups, there was negative correlation .part three: Feasibility study of applying ICK and TDI to quantitative analysis of right ventricular diastolic function of heart failure patientsmethods: The right ventricular diastolic function of 20 HF patients and 30 caseshealthy people at the same age were checked by the ICK and TDI respectivel, the CK-DI and TDI value were quantitated respectively, the results were analyzed by the statistic software.results: Compared with the normal control, the CK-DI value of the right ventricular free wall and the every interventricular septum segment of the HF patients were decreased significantly (P<0.01, P<0.05);Every TDI value was decreased (P<0.05) . The CK-DI and TDI value had correlation between the two groups.Conclusion1-. AQi and RVMPI can be used to evaluate the right ventricular systolic and diastolic function.The uniplanar area-macro diameter method can reflect the right ventricular systolic function.The tricuspid valve % pulmonary artery ^ left hepatic vein blood flow doppler technology was very useful to evaluate the diastolic function of the right ventricle.2> The TDI technology had higher sensitivity to evaluate the decrease of the right ventricle function,there was a significant meaning to measure the right ventricular free wall.3-.If the patients were suspected to have the right ventricular disfunction, according to the patients' clinical character, to select the suitable measurement methods, to selectively combine TDI with RVMPL tricuspid valve > pulmonary artery and left hepatic vein blood flow doppler technology can evaluate the right ventricle function more precisely.4> Adopting the ICK software assistant technology can make quantitation analysis about the CK diastolic image, can more precisely and easily reflect the right ventricular diastolic function at the real time, finally give the rapid and detailed data for evaluating the prognosis of the patients. It was useful to do further study on the clinical practice of CK technology.