Assessment Of Right Ventricular Systolic Function In Rheumatic Heart Disease Using Strain Rate Imaging And Real-Time Three-Dimensional Echocardiography

Objectives:Strain rate imaging (SRI) and Real-time Three-dimensional Echocardiography (RT-3DE) can assess the myocardial regional and global systolic function quantitatively. The purposes of the study are (1) to study the distribution regularity of normal adult right ventricular peak systolic strain rate SRs and peak strainε; (2) to assess right ventricular regional and global systolic function quantitatively in patients with rheumatic heart disease (RHD) using SRI and RT-3DE ; (3) to explore the correlation of right ventricular regional systolic function and global systolic function in patients with RHD.Methods:The study selected 50 healthy subjects and 55 patients with RHD,estimating pulmonary arterial systolic pressure(PASP) according to tricuspid regurgitation, patients with RHD were divided into mild, moderate, severe degree groups according to pulmonary hypertension (PH) (30~50 mmHg /51 ~70 mmHg />70 mmHg), each group are 24,16,15 patients respectively. The study analyzed right ventricular free wall (RVFW) and interventricular septum basal, middle and apical segments in the apical 4-chamber view using Philips IE33 ultrasonic imaging apparatus SRI , SRs andεwere acquired .RVEF were measured using RT-3DE at the same time.Results:1. Normal adult right ventricular free wall and interventricular septum basal, middle segments SRs,εare obviously higher than apical segments(P<0.01),middle segments SRs,εare higher than basal segments , but both have no statistics differenc(eP>0.05),right ventricular free wall three segments are significantly higher than corresponding interventricular septum segments(P<0.001).2.Right ventricular each segmentsεare reduced in patients with RHD PH mild, moderate, severe degree groups.Two groups comparison have statistics difference in normal group and PH mild, moderate, severe degree groups (P<0.05). Right ventricular each segments SRs are also reduced in patients with RHD . Two groups comparison have statistics difference(P<0.05)except normal group and mild group interventricular septum basal segments ,apical segments SRs;mild group and moderate group RVFW middle and apical segments SRs, moderate group and severe group RVFW basal segments ,interventricular septum basal segments,interventricular septum middle segments SRs.3.RVEF are also reduced in patients with RHD PH mild, moderate, severe degree groups . Two groups comparison have statistics difference(P<0.05)except normal group and mild group comparison.4.The relative good correlation were observed between the right ventricular each segments |ε|, |SRs| and RVEF , especially RVFW basal segment |ε|, |SRs| and RVEF have significant positive correlation(r = 0.85,P<0.01;r = 0.80,P<0.01).Conclusions:1. The distribution regularity of normal adult right ventricular SRs,ε: RVFW , interventricular septum middle segments SRs,εare highest , but have no statistics difference with basal segments , middle segment and basal segment SRs,εare obviously higher than apical segment . RVFW three segments are significantly higher than corresponding interventricular septum segments.2.Right ventricular regional and global systolic function in patients with RHD are reduced . The reduction of regional systolic function is earlier than global systolic function,soε, SRs are sensitive indexes in reflecting the change of right ventricular systolic function .3.There are relative good correlation between right ventricular regional and global systolic function in patients with RHD, especially RVFW basal segment |ε|, |SRs| and RVEF have significant positive correlation, which can relative accurately estimate right ventricular systolic function quantitatively.