Evaluation Of Right Cardiac Structure And Function In Patients With Chronic Obstructive Pulmonary Disease By Two-dimensional And Real-time Three-dimensional Echocardiography

Objective:The right heart structure and functional changes of chronic obstructive pulmonary disease(COPD)were evaluated by using two-dimensional and real-time three-dimensional echocardiography(RT-3DE).Methods:60 cases of COPD patients admitted to the respiratory department of The Second Affiliated Hospital of Dalian Medical University from November 2016 to May 2017 were selected,and the course of diagnosis of COPD was divided into two groups:The diagnosis of COPD is less than 5 years in 30 cases(group A),17 cases of male patients,13 cases of female patients,aged 44-76 years,with an average age of 63.2 years;diagnosed COPD more than 10 years in 30 cases(B group),18 cases of male patients,female patients in 12 cases,aged 44-81 years,with an average age of 64.9 years;another healthy control group of 30 patients(C group),including 16 males and 14 females,aged 55-77 years,mean age 66.8 years old,There was no significant difference in age,height,weight and blood pressure between groups.Cases A and B were diagnosed as chronic obstructive pulmonary disease is based on clinical symptoms and signs of patients,imaging examination,and pulmonary function tests to exclude factors that lead to changes in right heart structure and function such as hypertrophic cardiomyopathy,valvular disease,congenital heart disease,coronary heart disease,hypertension,diabetes mellitus and other factors,except for the influence of pulmonary other factors on right heart structure and function,such as pulmonary parenchymal lesions(lesions over a section),lung benign or malignant tumor and pleural effusion.The conventional two-dimensional echocardiography and RT-3DE were used to determine the right-heart related parameters in three groups.1,The two-dimensional ultrasonic parameters of the three groups were measured:right atrium left and right diameter(RAd1),right atrium up and down diameter(RAd2),right atrial diastolic maximum area(RAA),right ventricular anterior wall thickness(RVAWd),the basal parts of right ventricular diameter in end-diastolic(Basal RVd),M-type ultrasonography measures tricuspid annular plane systolic excursion(TAPSE),doppler ultrasonography measures the ratio of E-peak of tricuspid valve to right ventricular side of the valve ring diastolic early E 'peak(E/E '),by tricuspid regurgitation velocity,to estimate pulmonary artery systolic pressure(PASP).2,Three sets of real-time 3D ultrasound parameters were measured: right ventricular end diastolic maximum volume(RVEDV),right ventricular end systolic minimum volume(RVESV),right ventricular ejection fraction(RVEF).Results:1,Three sets of two-dimensional echocardiographic measurements: the case B group compared with the case A group and the control C group,RAd1,RAd2,Basal RVd,RVAWd,RAA,E/E,PASP value was increased,the difference was statistically significant(P<0.05);tricuspid annular plane systolic excursion(TAPSE)tended to decrease,and the difference was statistically significant(P<0.05).There was no significant difference in RAd1,RAd2 and RAA between group A and group C,but Basal RVd?RVAWd?TAPSE?E/E' and PASP were increased,the difference was statistically significant(P <0.05).2,Three groups of real-time three-dimensional echocardiography measurements: Compared with the control A group and the case C group,the RVESV and RVEDV showed an increasing trend in the case B group,and the difference was statistically significant(P<0.05),RVEF has decreased,the difference was statistically significant(P<0.05).Compared with the control group C,the RVEDV and RVEF showed an increasing trend,and RVESV showed a decreasing trend in the case group A,and the difference was statistically significant(P<0.05).Conclusion:1,The early right ventricular structure in patients with chronic obstructive pulmonary disease(COPD)changes,pulmonary artery pressure,increased systolic function,diastolic function decreased,with the progress of the right heart volume increased,right ventricular systolic and diastolic function were reduced.2.TAPSE can be simple,fast and accurate to reflect the right ventricular total systolic function,three-dimensional echocardiography can accurately reflect the right heart volume changes.Combined use of two-dimensional and real-time three-dimensional echocardiography to chronic obstructive pulmonary disease in patients with right heart structure and function of accurate assessment for clinical diagnosis and treatment to provide valuable information.