• 四川大學(xué)華西醫(yī)院　麻醉科，成都　610041;

右心功能不全或右心衰竭是一種復(fù)雜的臨床綜合征，常導(dǎo)致患者預(yù)后不良，病死率高。為早期發(fā)現(xiàn)右心功能障礙，及時(shí)指導(dǎo)治療和評價(jià)治療效果，對右心功能的監(jiān)測越來越引起臨床醫(yī)生的關(guān)注。超聲心動圖具有無創(chuàng)、準(zhǔn)確和重復(fù)性好等優(yōu)點(diǎn)而廣泛應(yīng)用于心功能的評價(jià)。我們就如何運(yùn)用超聲心動圖來簡便有效、準(zhǔn)確敏感地評價(jià)右心功能做一綜述，為其能進(jìn)一步推廣應(yīng)用于臨床打下良好的基礎(chǔ)。

引用本文： 彭玲,魏蔚. 超聲心動圖在右心功能評價(jià)中的應(yīng)用. 中國胸心血管外科臨床雜志, 2012, 19(6): 671-675. doi: 復(fù)制

1. 　Haddad F， Doyle R， Murphy DJ， et al. Right ventricular function in cardiovascular disease， part II：pathophysiology， clinical importance， and management of right ventricular failure. Circulation， 2008， 117 （13）：1717-1731.
2. 　Mangi AA. Right ventricular dysfunction in patients undergoing left ventricular assist device implantation：predictors， management， and device utilization. Cardiol Clin， 2011， 29 （4）：629-637.
3. 　Voelkel NF， Quaife RA， Leinwand LA， et al. Right ventricular function and failure：report of a National Heart， Lung， and Blood　Institute working group on cellular and molecular mechanisms of right heart failure. Circulation， 2006， 114 （17）：1883-1891.
4. 　Kurzyna M， Dabrowski M， Bielecki D， et al. Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension. Chest， 2007， 131 （4）：977-983.
5. 　Mclaughlin VV， Davis M. Hypertension arterial hypertension. Curr Probl Cardiol， 2011， 36 （12）：461-517.
6. 　Guarracino F， Cariello C， Danella A， et al. Right ventricular failure：　physiology and assessment. Minerva Anestesiol， 2005， 71 （6）：307-312.
7. 　Lindqvist P， Henein M， Kazzam E. Right ventricular outflow-tract fractional shortening：an applicable measure of right ventricular　systolic function. Eur J Echocardiogr， 2003， 4 （1）：29-35.
8. 　Zornoff LA， Skali H， Pfeffer MA， et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol， 2002， 39 （9）：1450-1455.
9. 　Rudski LG， Lai WW， Afilalo J， et al. CME exam for guidelines for the echocardiographic assessment of the right heart in adults：a report from the American Society of Echocardiography. J Am Soc　Echocardiogr， 2010， 23 （7）：786-788.
10. 　Kaul S， Tei C， Hopkins JM， et al. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J， 1984， 107 （3）：526-531.
11. 　Nagueh SF， Kopelen HA， Zoghbi WA. Relation of mean right atrial pressure to echocardiographic and Doppler parameters of right atrial and right ventricular function. Circulation， 1996， 93 （6）：1160-1169.
12. 　Torbicki A， Skwarski K， Hawrylkiewicz I， et al. Attempts at measuring pulmonary arterial pressure by means of Doppler echocardiography in patients with chronic lung disease. Eur Respir J， 1989，　2 （9）：856-860.
13. 　Gleason WL， Braunwald E. Studies on the first derivative of the ventricular pressure pulse in man. J Clin Invest， 1962， 41：80-91.
14. 　De Castro S， Cavarretta E， Milan A， et al. Usefulness of tricuspid annular velocity in identifying global RV dysfunction in patients with primary pulmonary hypertension：a comparison with 3D echo-derived right ventricular ejection fraction. Echocardiography， 2008， 25 （3）：289-293.
15. 　Andeeva IuA， Saidova MA， Martyniuk TV， et al. Tissue myocardial Dopplere chocardiographic evaluation of right ventricle function and the level of natriuretic peptides in patients with pulmonary hypertension of various etiologies. Ter Arkh， 2010， 82 （4）：27-34.
16. 　Vogel M， Derrick G， White PA， et al. Systemic ventricular function in patients with transposition of the great arteries after atrial repair：a tissue Doppler and conductance catheter study. J Am Coll Cardiol， 2004， 43 （1）：100-106.
17. 　Nageh MF， Kopelen HA， Zoghbi WA， et al. Estimation of mean right atrial pressure using tissue Doppler imaging. Am J Cardiol， 1999， 84 （12）：1448-1451.
18. 　Tei C， Ling LH， Hodge DO， et al. New index of combined systolic and diastolic myocardial performance：a simple and reproducible measure of cardiac function——a study in normals and dilated cardiomyopathy. J Cardiol， 1995， 26 （6）：357-366.
19. 　Sugiura T， Suzuki S， Hussein MH， et al. Usefulness of a new Dopplerindex for assessing both ventricular functions and pulmonary circulation in newborn Piglet with hypoxic pulmonary hypertension. Pediatr Res， 2003， 53 （6）：927-932.
20. 　Abd El Rahman MY， Abdul-Khaliq H， Vogel M， et al. Value of the new Doppler-derived myocardial performance index for the evaluation of right and left ventricular function following repair of tetralogy of fallot. Pediatr Cardiol， 2002， 23 （5）：502-507.
21. 　Sernich S， Carrasquero N， Lavie CJ， et al. Noninvasive assessment of the right and left ventricular function in neonates with congenital diaphragmatic hernia with persistent pulmonary hypertension before and after surgical repair. Ochsner J， 2006， 6 （2）：48-53.
22. 　Tei C， Dujardin KS， David OH， et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr， 1996， 9 （6）：838-847.
23. Grapsa I， Pavlopoulos H， Dawson D， et al. Retrospective study of pulmonary hypertensive patients：is right ventricular myocardial　performance index a vital prognostic factor?? Hellenic J Cardiol， 2007， 48 （3）：152-160.
24. 　Seyfarth HJ， Pankau H， Winkler J， et al. Correlation of TEI index and invasive parameters of rightheart function in PAH. Pneumologie，　2004， 58 （4）：217-221.
25. 　Vonk MC， Sander MH， van den Hoogen FH， et al. Right ventricle Tei-index：a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. Eur J Echocardiogr， 2007， 8 （5）：317-321.
26. 　Greenberg NL， Firstenberg MS， Castro PL， et al. Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation， 2002， 105 （1）：99-105.
27. 　Sachdev A， Villarraga HR， Frantz RP， et al. Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension. Chest， 2011， 139 （6）：1299-1309.
28. 　Pirat B， Mcculloch ML， Zoghbi WA. Evaluation of global and　regional right ventricular systolic function in patients with pulmonary hypertension using a novel speckle tracking method. Am J Cardiol， 2006， 98 （5）：699-704.
29. 　Fukuda Y， Tanaka H， Sugiyama D， et al. Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr， 2011， 24 （10）：1101-1108.
30. 　Buckberg G， Athanasuleas C， Saleh S， et al. Septal myocardial protection during cardiac surgery for prevention of right ventricular dysfunction. Anadolu Kardiyol Derg， 2008， 8 （Suppl 2）：108-116.
31. 　Jurcut R， Giusca S， La GA， et al. The echocardiographic assessment of the right ventricle：what to do in 2010?Eur J Echocardiogr， 2010， 11 （2）：81-96.
32. 　Ghio S， Klersy C， Magrini G， et al. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol， 2010， 140 （3）：272-278.
33. 　López-Candales A， Rajagopalan N， Kochar M， et al. Systolic　eccentricity index identifies right ventricular dysfunction in pulmonary hypertension. Int J Cardiol， 2008， 129 （3）：424-426.
34. 　López-Candales A， Bazaz R， Edelman K， et al. Apical systolic　eccentricity index：a better marker of right ventricular compromise in pulmonary hypertension. Echocardiography， 2010， 27 （5）：534-538.
35. 　Kolski BC， Khadivi B， Anawati M， et al. The dilated coronary sinus：utility of coronary sinus cross-sectional area and eccentricity index in differentiating right atrial pressure overload from persistent left superior vena cava. Echocardiography， 2011， 28 （8）：829-832.
36. 　Morikawa T， Murata M， Okuda S， et al. Quantitative analysis of right ventricular function in patients with pulmonary hypertension using three-dimensional echocardiography and a two-dimensional summation method compared to magnetic resonance imaging. Am J Cardiol， 2011， 107 （3）：484-489.
37. 　Calcutteea A， Chung R， Lindqvist P， et al. Differential right ventricular regional function and the effect of pulmonary hypertension：three-dimensional echo study. Heart， 2011， 97 （12）：1004-1011.
38. 　Grapsa J， O’regan DP， Pavlopoulos H， et al. Right ventricular　remodelling in pulmonary arterial hypertension with three-dimensional echocardiography：comparison with cardiac magnetic resonance imaging. Eur J Echocardiogr， 2010， 11 （1）：64-73.
39. 　Sukmawan R， Akasaka T， Watanabe N， et al. Quantitative assessment of right ventricular geometric remodeling in pulmonary hypertension secondary to left-sided heart disease using real-time three-dimensional echocardiography. Am J Cardiol， 2004， 94 （8）：1096-1099.
40. 　Badano LP， Ginghina C， Easaw J， et al. Right ventricle in pulmonary arterial hypertension：haemodynamics， structural changes，　imaging， and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr， 2010， 11 （1）：27-37.
  1. 1. 　Haddad F， Doyle R， Murphy DJ， et al. Right ventricular function in cardiovascular disease， part II：pathophysiology， clinical importance， and management of right ventricular failure. Circulation， 2008， 117 （13）：1717-1731.
  2. 2. 　Mangi AA. Right ventricular dysfunction in patients undergoing left ventricular assist device implantation：predictors， management， and device utilization. Cardiol Clin， 2011， 29 （4）：629-637.
  3. 3. 　Voelkel NF， Quaife RA， Leinwand LA， et al. Right ventricular function and failure：report of a National Heart， Lung， and Blood　Institute working group on cellular and molecular mechanisms of right heart failure. Circulation， 2006， 114 （17）：1883-1891.
  4. 4. 　Kurzyna M， Dabrowski M， Bielecki D， et al. Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension. Chest， 2007， 131 （4）：977-983.
  5. 5. 　Mclaughlin VV， Davis M. Hypertension arterial hypertension. Curr Probl Cardiol， 2011， 36 （12）：461-517.
  6. 6. 　Guarracino F， Cariello C， Danella A， et al. Right ventricular failure：　physiology and assessment. Minerva Anestesiol， 2005， 71 （6）：307-312.
  7. 7. 　Lindqvist P， Henein M， Kazzam E. Right ventricular outflow-tract fractional shortening：an applicable measure of right ventricular　systolic function. Eur J Echocardiogr， 2003， 4 （1）：29-35.
  8. 8. 　Zornoff LA， Skali H， Pfeffer MA， et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol， 2002， 39 （9）：1450-1455.
  9. 9. 　Rudski LG， Lai WW， Afilalo J， et al. CME exam for guidelines for the echocardiographic assessment of the right heart in adults：a report from the American Society of Echocardiography. J Am Soc　Echocardiogr， 2010， 23 （7）：786-788.
  10. 10. 　Kaul S， Tei C， Hopkins JM， et al. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J， 1984， 107 （3）：526-531.
  11. 11. 　Nagueh SF， Kopelen HA， Zoghbi WA. Relation of mean right atrial pressure to echocardiographic and Doppler parameters of right atrial and right ventricular function. Circulation， 1996， 93 （6）：1160-1169.
  12. 12. 　Torbicki A， Skwarski K， Hawrylkiewicz I， et al. Attempts at measuring pulmonary arterial pressure by means of Doppler echocardiography in patients with chronic lung disease. Eur Respir J， 1989，　2 （9）：856-860.
  13. 13. 　Gleason WL， Braunwald E. Studies on the first derivative of the ventricular pressure pulse in man. J Clin Invest， 1962， 41：80-91.
  14. 14. 　De Castro S， Cavarretta E， Milan A， et al. Usefulness of tricuspid annular velocity in identifying global RV dysfunction in patients with primary pulmonary hypertension：a comparison with 3D echo-derived right ventricular ejection fraction. Echocardiography， 2008， 25 （3）：289-293.
  15. 15. 　Andeeva IuA， Saidova MA， Martyniuk TV， et al. Tissue myocardial Dopplere chocardiographic evaluation of right ventricle function and the level of natriuretic peptides in patients with pulmonary hypertension of various etiologies. Ter Arkh， 2010， 82 （4）：27-34.
  16. 16. 　Vogel M， Derrick G， White PA， et al. Systemic ventricular function in patients with transposition of the great arteries after atrial repair：a tissue Doppler and conductance catheter study. J Am Coll Cardiol， 2004， 43 （1）：100-106.
  17. 17. 　Nageh MF， Kopelen HA， Zoghbi WA， et al. Estimation of mean right atrial pressure using tissue Doppler imaging. Am J Cardiol， 1999， 84 （12）：1448-1451.
  18. 18. 　Tei C， Ling LH， Hodge DO， et al. New index of combined systolic and diastolic myocardial performance：a simple and reproducible measure of cardiac function——a study in normals and dilated cardiomyopathy. J Cardiol， 1995， 26 （6）：357-366.
  19. 19. 　Sugiura T， Suzuki S， Hussein MH， et al. Usefulness of a new Dopplerindex for assessing both ventricular functions and pulmonary circulation in newborn Piglet with hypoxic pulmonary hypertension. Pediatr Res， 2003， 53 （6）：927-932.
  20. 20. 　Abd El Rahman MY， Abdul-Khaliq H， Vogel M， et al. Value of the new Doppler-derived myocardial performance index for the evaluation of right and left ventricular function following repair of tetralogy of fallot. Pediatr Cardiol， 2002， 23 （5）：502-507.
  21. 21. 　Sernich S， Carrasquero N， Lavie CJ， et al. Noninvasive assessment of the right and left ventricular function in neonates with congenital diaphragmatic hernia with persistent pulmonary hypertension before and after surgical repair. Ochsner J， 2006， 6 （2）：48-53.
  22. 22. 　Tei C， Dujardin KS， David OH， et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr， 1996， 9 （6）：838-847.
  23. 23. Grapsa I， Pavlopoulos H， Dawson D， et al. Retrospective study of pulmonary hypertensive patients：is right ventricular myocardial　performance index a vital prognostic factor?? Hellenic J Cardiol， 2007， 48 （3）：152-160.
  24. 24. 　Seyfarth HJ， Pankau H， Winkler J， et al. Correlation of TEI index and invasive parameters of rightheart function in PAH. Pneumologie，　2004， 58 （4）：217-221.
  25. 25. 　Vonk MC， Sander MH， van den Hoogen FH， et al. Right ventricle Tei-index：a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. Eur J Echocardiogr， 2007， 8 （5）：317-321.
  26. 26. 　Greenberg NL， Firstenberg MS， Castro PL， et al. Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation， 2002， 105 （1）：99-105.
  27. 27. 　Sachdev A， Villarraga HR， Frantz RP， et al. Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension. Chest， 2011， 139 （6）：1299-1309.
  28. 28. 　Pirat B， Mcculloch ML， Zoghbi WA. Evaluation of global and　regional right ventricular systolic function in patients with pulmonary hypertension using a novel speckle tracking method. Am J Cardiol， 2006， 98 （5）：699-704.
  29. 29. 　Fukuda Y， Tanaka H， Sugiyama D， et al. Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr， 2011， 24 （10）：1101-1108.
  30. 30. 　Buckberg G， Athanasuleas C， Saleh S， et al. Septal myocardial protection during cardiac surgery for prevention of right ventricular dysfunction. Anadolu Kardiyol Derg， 2008， 8 （Suppl 2）：108-116.
  31. 31. 　Jurcut R， Giusca S， La GA， et al. The echocardiographic assessment of the right ventricle：what to do in 2010?Eur J Echocardiogr， 2010， 11 （2）：81-96.
  32. 32. 　Ghio S， Klersy C， Magrini G， et al. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol， 2010， 140 （3）：272-278.
  33. 33. 　López-Candales A， Rajagopalan N， Kochar M， et al. Systolic　eccentricity index identifies right ventricular dysfunction in pulmonary hypertension. Int J Cardiol， 2008， 129 （3）：424-426.
  34. 34. 　López-Candales A， Bazaz R， Edelman K， et al. Apical systolic　eccentricity index：a better marker of right ventricular compromise in pulmonary hypertension. Echocardiography， 2010， 27 （5）：534-538.
  35. 35. 　Kolski BC， Khadivi B， Anawati M， et al. The dilated coronary sinus：utility of coronary sinus cross-sectional area and eccentricity index in differentiating right atrial pressure overload from persistent left superior vena cava. Echocardiography， 2011， 28 （8）：829-832.
  36. 36. 　Morikawa T， Murata M， Okuda S， et al. Quantitative analysis of right ventricular function in patients with pulmonary hypertension using three-dimensional echocardiography and a two-dimensional summation method compared to magnetic resonance imaging. Am J Cardiol， 2011， 107 （3）：484-489.
  37. 37. 　Calcutteea A， Chung R， Lindqvist P， et al. Differential right ventricular regional function and the effect of pulmonary hypertension：three-dimensional echo study. Heart， 2011， 97 （12）：1004-1011.
  38. 38. 　Grapsa J， O’regan DP， Pavlopoulos H， et al. Right ventricular　remodelling in pulmonary arterial hypertension with three-dimensional echocardiography：comparison with cardiac magnetic resonance imaging. Eur J Echocardiogr， 2010， 11 （1）：64-73.
  39. 39. 　Sukmawan R， Akasaka T， Watanabe N， et al. Quantitative assessment of right ventricular geometric remodeling in pulmonary hypertension secondary to left-sided heart disease using real-time three-dimensional echocardiography. Am J Cardiol， 2004， 94 （8）：1096-1099.
  40. 40. 　Badano LP， Ginghina C， Easaw J， et al. Right ventricle in pulmonary arterial hypertension：haemodynamics， structural changes，　imaging， and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr， 2010， 11 （1）：27-37.