| Cardiac dysfunction is a contain pathological state that is familiar for us. Right ventricle has ever been termed as "the forgotten ventricle" because the clinical manifestatios of right ventricular dysfunction is insidious.However,it has proven to be an important prognostic variable in patients with severe heart failure even with established LV failure.Some tudies have focused on the role of RV dysfunction in patients with mild or moderate heat failure. Previous reports have documented a possible relationship between RVEF and exercise capacity in HF patients.Besides,assessment of right ventricular function plays an important role in patients with right heart disease such as COPD, pulmonary embolism,pulmonary heart disease, arrhythmogenic right ventricular cardiomyopathy and so on.In a word,right ventricular function evaluation has been developing from ignore to attention,from qualitative to quantitative.And it has become a hot topic in medical research now.Among all the imaging methods,chest radiograph cannot evaluate RVEF.Right ventricular angiography is used little because of invasive and ionizing radiation,even though it is easier and less time and money-consuming.Likewise,the clinical and research applications of MSCT are also affected by ionizing radiation and the contract agents.PET can make well image and obtain accurate RVEF,but it cannot be accepted by most patients because of high price.SPECT developed on the basis of it greatly reduced patients’economic burden,and imaging don’t depend on right ventricular morphology.But the limited number of photon results affect the image resolution and the accuracy of RVEF.The image quality,time and spatial resolution of CMR are high,but its clinical utility is limited due to its high price,time-consuming and various contraindications.Echocardiography is the most usually used cardiac examination because it is safe,easily,noninvasive,without ionizing radiation,and applicable to patients with pacemakers and defibrillators.Traditional right volume indicators such as EDV,ESV,SV various a lot among individuals or measuring methods and has a low accuracy.Its clinical application is limitted.TEI index proposed by Japanese scholar could evaluate right ventricular systolic and diastolic function comprehensively and is little influenced by age, heart rate, blood pressure, cardiac load changes and right ventricular morphology.But it has lower sensitivity and specificity for cardiac contractility.Tissue Doppler imaging technique and myocardial strain imaging technique developed on the basis of it have become a hot topic in recent years.Both of them are used to evaluate local and global cadiac function and are not affected by right ventricular morphology.But the effect in cardiac fuction evaluation is not satisfactory.RVEF is highly dependent on cardiac load.It cannot adequately reflect cardiac contractility.Now it’s the most commonly used indicator of right ventricular function and playing an important role in clinical practice.The present analysis was designed to investigate the calculation of RVEF.In current stage, M-mode echocardiographic RVEF has almost been eliminated, while the level of real-time three-dimensional technology is limitary,so that its spatial and temporal resolution of the image and the accuracy of RVEF are lower than two-dimensional ultrasound. Its complex calculation software is also difficult to meet the needs of the daily work.Two-dimensional area-length method and Simpson’ smethod are the first choice for evaluation of RVEF.But it is limitted by fundamental section.Conventional four-chamber view cannot show right ventricular outflow tract;Aorta short axis view cannot show right ventricular apical trabecular ministry;While Right ventricular outflow tract section cannot show right ventricular inflow tract.And right ventricular short axis view is usually used for evaluation regional myocardial systolic performance but not whole observation.It is considerable for the accuracy of each evaluation.Right cardiac function plays an important role in diagnosis and prognosis of congenital heart disease. But the application of right ventricular angiography is limitted in cardiac catheterization, and the measurement accuracy of echocardiography is unsatisfied due to various factors. Now a more accurate and atraumatic evaluation measure is needed.Objective:A novel method was developed for calculating right ventricular ejection fraction (RVEF) from total right ventricular view of two-dimensional echocardiography, and was compared to the conventional four chamber view and right ventricular angiography of right anterior oblique.Methods:Patient selection:Between April2011and November2011,22patients of congenital heart disease with right ventricular dilatation and abnormal hemodynamics (13men and9women, aged16-67years) were admitted into our institute.Echocardiographic study:RVEF was calculated from two cross-sectional echocardiographic views:the four chamber view and the total right ventricular view. We also record EDV,ESV,SV of total right ventricular view during examinations.cardiac catheterization:In the cardiac catheterization laboratory, RVEF was calculated from right anterior oblique view of right ventricular angiography. We also record EDV, ESV, SV during catheterization.Statistical analysis:Analysis of Variance for randomized block design was used for three groups of RVEF in order to study the efficiency of the total right ventricular view in RV function evaluation.Pearson correlation analysis and correspondence analysis were used for two groups of RVEF obtained from total right ventricular view and right ventricular angiography in order to study the accuracy of the total right ventricular view in RV function evaluation. We also used Bland-Altman plot of the two groups respectively to evaluate the consistency of the two techniques. Two related samples nonparametric test were used to compare EDV, ESV and SV of the two methods.Correlation coefficient between four chamber view RVEF and right ventricular angiography RVEF was also calculated and was compared to the same indicator between total right ventricular view and right ventricular angiography in order to study the superiority of the total right ventricular view in RV function echocardiographic evaluation.Results:RVEFs measured by the three methods were48.0±11.3(total right ventricular view),49.5±13.1(four-chamber view), and48.7±12.1(right ventricular angiography), respectively, and had no statistical significance(F=0.327, P=0.723).The total right ventricular view RVEF and right ventricular angiography RVEF were highly correlated(r=0.885,P<0.001).Consistency range was-10.71～9.06%, suggested a well consistency between the two methods. Consistency range of the two methods were respectively-10.98～12.63%(total right ventricular view)and-7.56～10.54%(right ventricular angiography),suggested well repeatability of the two methods.There were statistically difference of the volume indicators between the two methods (EDV:Z=-3.059, P=0.002; ESV:Z=-3.059, P=0.002; SV:Z=-3.059, P=0.002).The four-chamber view RVEF and right ventricular angiography RVEF were moderately correlated(r=0.659, P=0.001). While the correlation between total right ventricular view and angiography was significantly higher.Conclusion:This study confirms that RVEF of total right ventricular view is highly correlated with the RVEF of right ventricular angiography and it’s better than the four chamber view. It may be an accurate and reliable method for evaluation of right ventricular systolic function. |
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