| Objectives To analyse the efficacy of echocardiographic parameters in evaluating right ventricular function, and analysis the differences and characteristics of echocardiographic parameters under different conditions according to left heart function. Then to seek the best diagnosis model and to explore its value in the diagnosis of right heart failure.Methods 1 39 patients with right heart failure(RHF), 34 patients with whole heart failure(WHF) and 41 normal people were included. 2 All subjects were examined by trans-thoracic echocardiography. The right ventricular fractional area change(RVFAC),tricuspid annular plane systolic excursion(TAPSE), tricuspid flow peak velocity at early diastole(E), tricuspid annular peak systolic velocity(Sm) and peak early diastolic velocity(Em), right ventricular myocardial performance index(RVMPI), isovolumic acceleration(IVA) at tricuspid annular and the peak systolic strain(Ssb, Ssm, Ssa), strain rate(SRsb, SRsm, SRsa) and the early diastolic strain rate(SReb, SRem, SRea) of right ventricular free wall, interventricular septum and left ventricular wall were measured and calculated. 3 The data were evaluated by one-way ANOVA between three groups. The independent sample t-test was used to compared between two groups. The correlation between two indicators was conducted with Pearson correlation analysis. Linear regression analysis was used to screen indexes that affect the echocardiographic parameters. Discriminant analysis was used to establish the diagnosis model. Test standard: P<0.05.Results 1 There were no statistically significant differences in echocardiographic parameters between WHF group and RHF group, except for RVFAC, which was lower in WHF group. 2 The the peak systolic strain(Ssb, Ssm, Ssa) and strain rate(SRsb, SRsm,SRsa) of RV free wall and IVS were significantly reduced in patients with WHF compared with in RHF group. 3 The diagnosis efficacy of parameters in WHF group were better than those parameters in RHF group, especially RVFAC and Sm. 4Correlation analysis: LVEF and LVSs were respectively positively correlated with RVFAC, TAPSE, Sm and IVA, and were negatively correlated with RVMPI. LVSRe were positively correlated with E/Em. 5 Linear regression analysis: RVFAC was closely associated with IVS Ssm, and Sm closely associated with the RV free wall Ssb. This shows that IVS Ssm was the main factor that caused the difference of RVFAC in two groups, and the RV free wall Ssb was the main factor that caused the difference of Sm in two groups. 6 Discriminant model: 1) When the patients with normal left heart function,the discriminant modal for: normal control group F=1.985 ? TAPSE + 2.713 ? Sm +5.955 ? IVA-0.134 ? E/Em-47.171; RHF group F=1.187 ? TAPSE +1.574 ? Sm+3.388 ? IVA + 0.181 ? E/Em- 18.090. 2) When the patients with left heart failure,discriminant modal for : non-RHF group F=0.384 ? RVFAC + 1.725 ? TAPSE +1.361? Sm+6.942? IVA-46.796; WHF group F=0.156? RVFAC+1.134?TAPSE+0.704 ? Sm+3.657 ? IVA-15.053. The accuracy rates by cross validation were higher than the rates of these single parameters.Conclusions 1 Echocardiographic parameters were effective parameters to evaluated right heart function. 2 Left ventricular failure had an impact on the RVFAC, TAPSE,RVMPI, E/Em, Sm and IVA, when it reduced, the RVFAC, TAPSE, E/Em, Sm and IVA would decreased, while the RVMPI would increased. 3 The effect of same parameter to evaluate right ventricular function with WHF was better when compared it with RHF. 4The discriminant model based on echocardiographic parameters had a preferable efficacy than any single echocardiographic parameter, this model can make more precise diagnosis in evaluating of right ventricular function. At the same time, it could provided evidence for the existence of right heart failure in patients with left heart failure. |
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