Evaluation Of Right Ventricular Systolic Function And Synchrony In Patients With Pulmonary Hypertension By Real-time Three-dimensional Echocardiography And Velocity Vector Imaging

Objective:This study was designed to evaluate right ventricular systolic function and synchrony in patients with pulmonary hypertension using real-time three-dimensional echocardiography combined with velocity vector imaging.The aim of this study is to provide a valuable reference for the early detection of changes in PAH patients and their right heart function.in accordance with.Methods: Eighty-six patients with PAH diagnosed at the First Hospital of Lanzhou from March 2017 to October 2017 were enrolled.According to the level of PASP,26 patients were mild(PASP=30~50 mmHg),moderate(PASP).=50~70mmHg)29 patients in the 31 patients and the severe group(PASP ? 70 mmHg).Another 30 healthy and age-matched healthy people were included as normal controls.All patients underwent RT-3DE examination and stored images.2D(2D)measurement of conventional right heart structure,function and hemodynamic parameters,including RVFAC,TAPSE,tricuspid annulus Doppler systolic peak velocity(S),PASP,3D analysis software to obtain RV end-diastolic volume(RVEDV-3D)and RV end-systolic volume(RVESV-3D),divided by BSA normalization,RV ejection(RVSV-3D),RVEF(RVEF-3D),to evaluate the overall contractile function of RV,compare these parameters between the groups were further analyzed.The correlation between RV3 D parameters,conventional RV2 D functional parameters and PASP was analyzed.The transverse,LS and strain rates of RV myocardium free wall and interventricular septum were obtained by VVI.globle Strain(GS),globle strain rate(GSR),standard deviation of strain peak time(SD-Ts),and standard deviation of strain rate peak time(SD-Tsr)to assess the overall and local systolic function of the patient's RV Synchronization.Result: ?FAC,TAPSE,and S were all decreased in the normal control group and the mild,moderate,and severe PAH groups.There were significant differences between the groups(P<0.05).?The end-diastolic volume(RVEDV-3D)and end-systolic volume(RVESV-3D)of each group of PAH were higher than that of the normal group,and then BSA,respectively,obtained RVEDVI and RVESVI,both with the increase of pulmonary artery pressure,RVEDVI and RVESVI were increasing gradually,the difference between the groups were statistically significant(P<0.05),while RVSV and RVEF were lower than the normal group,with the increase of pulmonary artery pressure,RVSV and RVEF showed a gradual decrease trend,except for the normal group.There was no statistical difference between the mild group and the PAH group.The trend was gradually decreased with the increase of pulmonary artery pressure.The difference between the groups was statistically significant(P<0.05);?Correlation: Pulmonary arterial pressure was negatively correlated with FAC,TAPSE,S and significantly negative correlation;pulmonary artery pressure was positively correlated with RVEDVI and RVESVI(P<0.05)and positively correlated(P<0.01),pulmonary artery pressure and RVEF,RVSV was negatively correlated(P<0.05)and significantly negatively correlated(P<0.01);?The transverse,LSR and strain absolute values of the control,PAH mild,moderate,and severe groups gradually decreased,and there were statistical differences in most stages.The RV free wall and ventricular septal basal and apical segments were The strain and strain values at each stage were reduced from the base to the heart tip(P<0.05);?Compared with the control group,the globle strain(GS)and strain rate(GSR)of the RV in the PAH group decreased,and decreased with the increase of pulmonary artery pressure.There was significant difference between the groups(P<0.05).);?In the PAH group,the local peak of the contraction occurred earlier,the standard deviation of the strain peak time(SD-Ts),the standard deviation of the strain rate peak time(SD-Tsr)increased,and gradually increased with the increase of pulmonary artery pressure.Increased,and there was a statistically significant difference between the groups(P<0.05);?Correlation between RV synchronization and RV shrinkage function and PASP.The standard deviation of RV strain peak time has a positive correlation with PASP(r=0.324,P=0.001),and has a positive positive correlation with GS,GSR,EF)(r=-0.292 P= 0.003,r=-0.245 P =0.014,r=-0.509 P=0.001),the standard deviation of RV strain rate peak time has a moderate positive correlation with PASP(r=0.429P=0.001),and has a negative correlation with GS,GSR,EF(r =-0.534 P=0.001,r=-0.331 P=0.001,r=-0.391 P=0.001).Conclusions: ?Patients with PAH showed a decrease in RV function.As the pulmonary artery pressure increased,the local and overall function of RV decreased progressively;?The myocardial strain and strain rate of RV segments were decreased in the early stage of PAH patients.The local systolic function was progressively impaired with the increase of pulmonary artery pressure.VVI can more sensitively evaluate the local and overall systolic function and synchronization of RV in patients with PAH.Sexuality can be applied in clinical routines;3.RT-3DE combined with VVI can comprehensively and in detail evaluate the RV function of patients with PAH,and it is characterized by non-invasive,simple and sensitive.