Assessment Of Right Ventricular Systolic Function By Real-time Three-dimensional Echocardiography

[Objective]To⑴evaluate the feasibility and accuracy of real - time three - dimensional echocardiography for quantifying right ventricular systolic function in animal experiment and clinical research.⑵investigate the normal reference value range of right ventricular in healthy subjects by real - time three - dimensional echocardiography.[Methods]1. Animal experiment :10 excised pig hearts were included in this study. Full volume images were acquired by real - time three - dimensional echocardiography (RT-3DE) , then were analyzed by softwares of Germany TomTec company: 4D RV-Function1.1 and AL 8-plane. The global right ventricular volumes were acquired by two methods. The true right ventricular volume was measured by water displacement ,which served as a reference standard.2. Clinical research :2.1 33 patients with atrial septal defect(ASD) were included in this study. Full volume images were acquired by RT-3DE ,then were analyzed by 4DRV-Function1.1 (4D-RVF). End-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF) of the global and three segments (inflow region, body region, outflow region) of right ventricular were acquired. 35 healthy subjects were included in this study as a normal control group.2.2 Choose 98 healthy adults, full volume images were acquired by RT-3DE , then were analyzed by 4D-RVF.⑴The global EDV, ESV and RVEF of right ventricular were acquired as a reference value. ⑵98 normal adults were divided into two groups according to gender:female group(n=46) and male group(n=52).The global EDV, ESV and RVEF of right ventricular were acquired.⑶Divided 98 normal adults into three groups according to the world health organization recommends:Youth group(< 45 years old, n=28), Middle-aged group (45-60 years, n=22) and Old group(> 60 years, n=48). The global EDV, ESV and RVEF of right ventricular were acquired.[Results]1. Animal experiment : The average RV volumes of 10 excised pig hearts were:4D-RVF method:(22.46±4.31)ml;AL 8-plane method:(20.94±3.98)ml;Water displacement method:(22.05±4.97)ml。No significant difference were found in right ventricular volume among three methods (F =0.31, p>0.05). Furthermore, the measurement of right ventricular volume with 4D-RVF method was better correlated with the reference value than AL 8-plane method : r1 = 0.93 , r2 = 0.82 , respectively.2. Clinical research :2.1. comparison of 33 cases of ASD and 35 cases of healthy adults:⑴The global right ventricular volume and ejection fraction of ASD group: EDV(152.02±29.07)ml, ESV (78.46±18.04)ml, RVEF (47.43±11.50)%. NOR group: EDV(89.35±11.57)ml,ESV(45.62±9.95)ml, RVEF(53.53±10.69)%. Between the two groups, EDV, ESV and RVEF were all significant difference (p < 0.05). The regional rEDV, rESV of ASD group is significant greater than NOR group(p < 0.01).The body region and outflow region rRVEF of ASD group were significant difference from NOR group(p < 0.05), but the inflow region rRVEF of ASD group was not significant difference from NOR group(p > 0.05).⑵rRVEF of three sections of ASD group : inflow region(54.88±12.86)% , body region(37.09±11.43)%, outflow region(46.55±12.77)%, respectively. From the findings of variance test, there were significant difference among three sections(F =17.09, p =0.00). ⑶rRVEF of three sections of NOR group : inflow region(58.69±6.96)% , , body region(52.58±9.77)%, outflow region(63.25±7.93)%, respectively. From the findings of variance test, there were significant difference among three sections(F =14.55, p=0.00).⑷We preliminarily deduced the tendency of right ventricular systolic in ASD patients is as follows: inflow region>outflow region>body region. But the tendency in NOR adults is as follows: outflow region>inflow region>body region.2.2 right ventricular echocardiographic measurements of 98 normal adults:⑴The global right ventricular volume and ejection fraction of 98 normal adults: EDV(92.47±31.83)ml, ESV(40.69±17.42)ml, RVEF(56.47±6.65)%.⑵Female group : EDV(85.18±35.30)ml, ESV(37.68±19.95)ml, RVEF(56.36±7.00)%。Male group: EDV(98.92±27.14)ml, ESV(43.34±14.51)ml, RVEF(56.56±6.39)%。Between the two groups, EDV was significant difference (p < 0.05), but ESV and RVEF were no significant difference(p>0.05).⑶Youth group : EDV(103.63±34.47) ml, ESV(46.56±21.13)ml, RVEF(55.98±6.45) %. Middle-aged group: EDV(93.79±32.71) ml, ESV(40.78±15.49)ml, RVEF(56.56±5.93) %。Old group: EDV(85.36±28.34 )ml,ESV (37.22±15.15)ml,RVEF( 56.71±7.17) %。From the findings of variance test, there were no significant difference among three groups in EDV, ESV, RVEF (F1 =3.06, F2 =2.63 , F3 =0.11, p>0.05).[Conclusion]Real-time three-dimensional echocardiographic technique can quantify right ventricular volume quickly and accurately. Combined with the special right ventricular software can also provide overall and segmental volume and ejection fraction dates. This new method for assessment regional right ventricular systolic function can provide detailed information for clinical diagnosis and treatment.