| Objective: To evaluate the right ventricular function of dilated cardiomyopathy(DCM)patients in different type by four-dimensional echocardiography, and discuss the influenceof regional myocardial motion on right ventricular systolic function in DCM patients,analyze the symptom of heart failure and long-term prognosis changed by variation of rightventricular systolic function and regional myocardial motion.Methods: Seventy-three patients and thirty-six healthy subjects (Group C) werestudied. Patients were divided into two group according to the size of right ventricular (RV)measured by two-dimensional ultrasound images in apical four-chamber view with focuson the right ventricle. Group A is patients with normal size RV while group B is thepatients with larger size RV. There are thirty-nine patients in Group A, nine of them arefemale, while thirty-four patients in Group B, and six of them are female. Group C includeseventeen females.Regular data were gained by GE Vivid E9ultrasonic diagnostic apparatus, includesright atrial diameter, right ventricular basal diameter, right ventricular longitudinaldimension and mid cavity RV minor dimensions, peak velocity of tricuspid valveregurgitation and differential pressure, left ventricular diastolic dimension and leftventricular ejection fraction. Four-dimensional echocardiography were performed in thosepatients and healthy controls, RV myocardial peak systolic strain(PSS) in apicalfour-chamber, two-chamber views with focus on the right ventricle and RV outflow tractview can be gained by three-dimensional speckle tracking imaging in the same time. PSSincluding the global peak longitudinal strain (GPSL), global peak circumferentialstrain(GPSC), global peak area strain(GPSA) and global peak radial strain (GPSR);Spherical index(SPI) of RV and each regional myocardial strain of RV in the same timewere calculated by onboard software automatically. Run the RV volume analysis software; draw the endocardium boundary of RV in long axis, short axis view and sagittal plane ofRV outflow tract. Build four-dimensional RV model to measure the volume and ejectionfraction of RV, and obtain the volume-time curve of RV.Results:1. There is no significant difference of general condition between normalcontrol group and DCM group in the statistics. The normal control group has a balancedproportion of man and woman while the DCM group has significant higher proportion ofmales.2. Ejection fraction of RV obtained by RV volume analysis software were significantpositive correlation with that measured by general tri-plane method (γ=0.886，P <0.01).RV volume measured by four-dimensional imaging is larger than tri-plane imaging.3. The Ejection fraction of RV in Group A and B is lower than normal value and isalso lower than that in Group C, the ejection fraction of RV was statistically significantdifference between group A and group B (P <0.01). Ejection fraction of Group B is lowerthan that of Group A. The volume of right ventricular in Group B is larger than Group Aand C, and there is no significant volume difference between Group A and Group C in thestatistics (P=0.669).4.The absolute value of GPSL、 GPSC、 GPSA and GPSR measured bythree-dimensional speckle tracking imaging in Group A and B were lower than Group C.Peak systolic strain was significant relevant to the ejection fraction of RV, SPI is relevant toGPSL and GPSR only when the volume expand to more than normal size. The softwaredivided RV myocardium into17segments by segmental standard of left ventricular.Analyze the remaining10segments of RV without ventricular septum and the apicalsegment which is always not well tracking. Inter-group comparisons were used. Therewere no significant differences between the three groups in circumferential strain. Thedifference was statistically significant in longitudinal strain of RV mid lateral, RV mid freewall, RV apical anterolateral, RV apical free wall (P <0.05). The difference wasstatistically significant in area strain of RV mid lateral, RV mid free wall, RV mid posterior,RV apical free wall (P <0.05). Also, the difference was statistically significant in radialstrain of RV mid lateral, RV mid free wall, RV mid posterior, RV apical anterolateral, RVapical free wall (P <0.05).5. The left ventricular systolic function did not improve in the patients with DCMafter receiving the treatment. But ejection fraction of RV improved when the RV volume did not change significantly after treatment, especially in longitudinal strain and radialstrain.Conclusions:1.This study indicates that RV volume analysis software can evaluatethe RV volume and systolic function accurately and quantitatively, and this volume haswell correlation with those functional parameters measured by general tri-plane method.For volume estimation of irregular shape of the right ventricle is closer to the actualsituation due to four-dimensional reconstruction.2. Regional myocardial motion measured by three-dimensional speckle trackingimaging weakened in all directions as systolic function deteriorated in DCM patients whichthe RV volume is still in normal size. Although SPI reflect the ventricular remodeling, butit is not a sensitive index when the ventricular volume is normal. Only when the RVvolume larger enough, SPI shows the correlation with RV systolic function.3. The difference of regional RV myocardial motion has nothing to do with thecircumferential movement by further analysis of the10segments of RV myocardium, andmainly exists in longitudinal and radial movements, this can be seen most clearly in RVmid lateral, RV mid free wall and RV apical free wall.4. The symptoms of DCM patients mainly rely on right ventricular ejection fractionimprovement.5. Four-Dimensional Echocardiography assess RV volume more accurately and gainearly diagnosis of deterioration of RV systolic function. This technology provide moresensitive index in evaluate the RV function. |
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