The application of application four-dimensional automatic right ventricular quantitative analysis in the evaluation of right heart function after pulmonary resection
-
摘要:
目的 利用四维自动右心室定量分析技术（4D Auto RV）评价肺切除术后患者的早期右心室容积和功能变化情况。 方法 选取2021年1月~2022年12月在中国科学技术大学附属第一医院行胸腔镜下肺结节肺切除术的患者51例，其中单纯肺段或肺楔形切除25例，肺叶切除26例。在进行肺切除的术前和术后1月内行超声心动图检查，利用4D Auto RV技术评估肺切除术后右心室容积和功能的变化，右心室容积参数包括右室舒张末期容积（EDV）、右室收缩末期容积（ESV）、每搏输出量等。右心室功能参数包括右心室射血分数（RVEF）、三尖瓣环纵向位移（TAPSE）、面积变化分数（FAC）及右心室整体纵向应变（RV-GPLS）、游离壁侧纵向应变（RV-FWPLS）。 结果 胸腔镜下肺切除术后早期右心室容积增加，具体表现为手术前后的EDV、ESV发生变化（P < 0.05），每搏输出量在手术前后的变化无统计学意义（P > 0.05）。右心室功能参数FAC、RV-GPLS、RV-FWPLS在手术前后的差异有统计学意义（P < 0.05），其对手术引起的右心室功能改变较敏感，而RVEF和TAPSE在手术前后的变化差异无统计学意义（P > 0.05）。单纯肺段/楔形切除术与肺叶切除术两种手术切除范围对患者术后右心容积和功能参数变化差异无统计学意义（P > 0.05）。 结论 肺切除术后早期阶段，尽管患者可能未表现出明显的临床症状，但通过4D Auto RV技术发现术后右心室扩张，早期出现右心室轻度功能障碍，表现为FAC、RV-GPLS和RV-FWPLS减低。 Abstract:Objective To employ the advanced four-dimensional automated right ventricular quantification (4D Auto RV) technique as a tool for evaluating the early postoperative alterations in RV volume and function among patients who have undergone lung resection surgery. Methods A total of 51 patients who underwent thoracoscopic lung resection for pulmonary nodules in the First Affiliated Hospital of University of Science and Technology of China from January 2021 to December 2022 were selected, including 25 patients with simple segmental or wedge resection and 26 patients with lobectomy. Echocardiography was performed before and within 1 month after lung resection, and the change a in right ventricular volume and function after lung resection were assessed using the 4D Auto RV technique. Right ventricular volume parameters included end- diastolic volume (EDV), end- systolic volume (ESV), and stroke volume (SV). Right ventricular function parameters included right ventricular ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and right ventricular longitudinal strain values [global longitudinal strain (RV-GPLS), free wall longitudinal strain (RV-FWPLS)]. Results Following early stages post- thoracoscopic lung resection, there was a significant increase in right ventricular volume, manifesting as statistically significant changes in both EDV and ESV before and after surgery (P < 0.05). However, the change in stroke volume pre- and post- surgery did not reach statistical significance (P > 0.05). Upon further analysis of right ventricular functional parameters, there were significant statistical changes in FAC, RV-GPLS, and RV- FWPLS before and after surgery (P < 0.05), indicating that these parameters were more sensitive to the alterations in right ventricular function induced by the surgery. The changes in RVEF and TAPSE did not achieve statistical significance pre- and post- surgery (P > 0.05). The differences in post-operative right ventricular volume and functional parameter changes between patients undergoing either limited resection such as segmentectomy/wedge resection versus lobectomy were not statistically significant (P > 0.05). Conclusion In the phase following lung resection, despite the possible absence of overt clinical symptoms, the utilization of 4D Auto RV technology has revealed a phenomenon of right ventricular dilation, indicative of early onset of mild right ventricular dysfunction. This dysfunction manifests as decrements in FAC, RV-GPLS and RV-FWPLS. -
图 1 两种测量方法测量的36例患者右心功能的Bland-Altman图
Figure 1. Bland- Altman plots of right ventricular function in 36 patients measured by two measurement methods. The horizontal axis represents the average value of each object measured by the two methods, and the vertical axis represents the difference of each value measured by the two methods. In the Bland-Altman diagram, the orange dotted line is the zero scale line, the blue solid line is the mean line, the green vertical line on the vertical axis is the 95% CI of the mean, the dark brown dotted line is the LoA line, and the blue vertical line on the ordinate is the 95% CI of the LoA).
表 1 4D Auto RV法和QAS法测量右心室容积参数
Table 1. The right ventricular volume parameters measured by 4D Auto RV method and QAS method (Mean±SD)
Parameter 4D Auto RV QAS EDV（mL） 92.97±27.90 89.97±22.04 ESV（mL） 43.22±14.68 38.53±14.60 EF（%） 57.56±0.08 52.80±0.07 EDV: End-diastolic volum; ESV: End-systolic volum; EF: Ejection fraction; 4D Auto RV: four-dimensional automated right ventricular quantification 
下载: 导出CSV
表 2 4D Auto RV法和QAS法计算右心室功能参数比较
Table 2. Comparison of right ventricular parameters calculated by 4D Auto RV method and QAS method
Parameter d Sd 95% LoA 95% CI P EDV (mL) 4.35 21.08 -2.78-11.49 -36.96-45.67 0.223 EDVi (mL/m2) 2.01 12.36 -2.17-6.20 -22.22-26.24 0.005 ESV (mL) 4.69 12.06 0.61-8.77 -18.94-28.33 0.026 ESVi (mL/m2) 2.75 7.09 0.35-5.15 -11.16-16.65 0.026 SV (mL) -1.17 15.24 -6.33-3.99 -31.05-28.71 0.650 EF (%) -0.05 0.10 -0.08- -0.01 -0.24-0.14 0.005 EDVi: End-diastolic volume index; ESVi: End-systolic volume index; SV: Stroke volume.
下载: 导出CSV
表 3 肺切除前、后的右心容积和功能参数比较
Table 3. Right heart volume and function parameters before and after lung resection (Mean±SD)
Parameter Pre-lobectomy（n=51） Post-lobectomy（n=51） t P EDV (mL) 92.89±26.12 101.20±28.94 -2.389 0.021 EDVi (mL/m2) 54.98±14.13 59.96±13.93 -2.391 0.021 ESV (mL) 43.41±13.94 48.94±13.75 -2.874 0.006 ESVi (mL/m2) 25.67±7.66 29.01±6.74 -2.857 0.006 SV (mL) 48.87±14.62 51.39±17.61 -1.221 0.228 RVEF (%) 52.81±6.49 51.47±4.09 1.342 0.186 TAPSE (mm) 21.28±2.55 21.21±2.16 0.182 0.856 FAC (%) 42.38±3.64 41.61±3.31 3.411 0.001 RV-GPLS (%) 22.03±3.20 20.82±2.57 -4.707 ＜0.001 RV-FWPLS (%) 27.56±4.07 22.87±2.73 -9.783 ＜0.001 RVEF: Right ventricular ejection fraction; TAPSE: Tricuspid annular plane systolic excursion; FAC: Area change fraction; RV-GPLS: Global right ventricular peak longitudinal strain; RV-FWPLS: Free wall peak longitudinal strain.
下载: 导出CSV
表 4 切除范围不同患者的术后容积和功能参数比较
Table 4. Comparison of volume and function parameters before and after surgery in patients with different resection ranges (Mean±SD)
Parameter Segmentectomy (n=26) Lobectomy (n=25) Mean difference Standard error t P EDV (mL) 95.00±25.22 107.65±31.57 -12.65 7.99 -1.584 0.120 EDVi (mL/m2) 57.51±12.52 62.52±14.82 -5.02 3.87 -1.296 0.201 ESV (mL) 46.20±11.25 51.80±15.66 -5.59 3.83 1.460 0.151 ESVi (mL/m2) 27.99±5.85 30.07±7.52 -5.02 3.87 -1.104 0.201 SV (mL) 48.80±15.34 54.08±19.64 -5.28 4.92 -1.073 0.289 RVEF (%) 51.07±5.03 51.88±2.84 -0.80 1.15 -0.699 0.488 TAPSE (mm) 20.93±2.18 21.50±2.12 -0.57 0.60 -0.948 0.348 FAC (%) 42.35±2.99 40.85±3.51 1.49 0.91 1.64 0.108 RV-GPLS (%) 21.26±2.67 20.36±2.41 -0.90 0.71 -1.265 0.212 RV-FWPLS (%) 23.49±2.89 22.23±2.45 -1.26 0.75 -1.672 0.101
下载: 导出CSV
-
[1] Glass A, McCall P, Arthur A, et al. Pulmonary artery wave reflection and right ventricular function after lung resection[J]. Br J Anaesth, 2023, 130(1): e128-e136. doi: 10.1016/j.bja.2022.07.052 [2] Giustiniano E, Nisi F, Piccioni F, et al. Right ventricle response to major lung resection (the RIVER study)[J]. J Cardiovasc Echogr, 2023, 33(2): 76-82. doi: 10.4103/jcecho.jcecho_17_23 [3] Tanita T, Tomoyasu M, Deguchi H, et al. Review of preoperative functional evaluation for lung resection using the right ventricular hemodynamic functions[J]. Ann Thorac Cardiovasc Surg, 2004, 10 (6): 333-9. [4] Venuta F, Sciomer S, Andreetti C, et al. Long-term Doppler echocardiographic evaluation of the right heart after major lung resections[J]. Eur J Cardiothorac Surg, 2007, 32(5): 787-90. doi: 10.1016/j.ejcts.2007.07.033 [5] 杨文荣, 李庄, 李爱民, 等. 肺叶切除术对局部非小细胞肺癌患者右心功能与生活质量的影响[J]. 大理大学学报, 2020, 5(4): 5. [6] Chen JF, Song DD, Sun ZY, et al. Effects of lung resection on heart structure and function: a tissue Doppler ultrasound survey of 43cases[J]. Biomed Rep, 2024, 20(1): 11. [7] Wu VCC, Takeuchi M. Three- dimensional echocardiography: current status and real-life applications[J]. Acta Cardiol Sin, 2017, 33(2): 107-18. [8] Penso M, Ranalletta RA, Pepi M, et al. Comparison between automatic and semiautomatic system for the 3D echocardiographic multiparametric evaluation of RV function and dimension[J]. J Clin Med, 2022, 11(15): 4528. doi: 10.3390/jcm11154528 [9] Wu WC, Liu BY, Huang M, et al. The role of four- dimensional automatic right ventricular quantification technology to determine RV function and hemodynamics in patients with pulmonary hypertension compared with right heart catheterization[J]. Front Cardiovasc Med, 2021, 8: 628610. doi: 10.3389/fcvm.2021.628610 [10] 杨曼曼, 崔存英, 张瑞, 等. 四维自动右心室定量分析技术评价扩张型心肌病患者右心室功能[J]. 中华超声影像学杂志, 2023, 32(6): 485-92. doi: 10.3760/cma.j.cn131148-20221201-00833 [11] Wharton G, Steeds R, Allen J, et al. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography[J]. Echo Res Pract, 2015, 2(1): G9-G24. doi: 10.1530/ERP-14-0079 [12] McCall PJ, Arthur A, Glass A, et al. The right ventricular response to lung resection[J]. J Thorac Cardiovasc Surg, 2019, 158(2): 556-65. e5. doi: 10.1016/j.jtcvs.2019.01.067 [13] Reed CE, Dorman BH, Spinale FG. Mechanisms of right ventricular dysfunction after pulmonary resection[J]. Ann Thorac Surg, 1996, 62(1): 225-32. doi: 10.1016/0003-4975(96)00258-5 [14] Elrakhawy HM, Alassal MA, Shaalan AM, et al. Impact of major pulmonary resections on right ventricular function: early postoperative changes[J]. Heart Surg Forum, 2018, 21(1): E009-E017. [15] Focardi M, Cameli M, Carbone SF, et al. Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance[J]. Eur Heart J Cardiovasc Imaging, 2015, 16(1): 47-52. doi: 10.1093/ehjci/jeu156 [16] McCall P, Soosay A, Kinsella J, et al. The utility of transthoracic echocardiographic measures of right ventricular systolic function in a lung resection cohort[J]. Echo Res Pract, 2019, 6(1): 7-15. [17] Wang ZH, Yuan JJ, Chu W, et al. Evaluation of left and right ventricular myocardial function after lung resection using speckle tracking echocardiography[J]. Medicine, 2016, 95(31): e4290. doi: 10.1097/MD.0000000000004290 [18] Potaris K, Athanasiou A, Konstantinou M, et al. Pulmonary hypertension after pneumonectomy for lung cancer[J]. Asian Cardiovasc Thorac Ann, 2014, 22(9): 1072-9. doi: 10.1177/0218492314527992 [19] Bolliger CT, Perruchoud AP. Functional evaluation of the lung resection candidate[J]. Eur Respir J, 1998, 11(1): 198-212. doi: 10.1183/09031936.98.11010198 [20] Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy?[J]. Eur Respir Rev, 2017, 26 (146): 170079. doi: 10.1183/16000617.0079-2017 [21] Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy[J]. Eur J Cardiothorac Surg, 2018, 53 (3): 640-7. doi: 10.1093/ejcts/ezx357 [22] Sachs E, Jackson V, Al-Ameri M, et al. Uniportal video-assisted thoracic surgery: segmentectomy versus lobectomy-early outcomes[J]. Eur J Cardiothorac Surg, 2024, 65(4): ezae127. doi: 10.1093/ejcts/ezae127 [23] Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non- inferiority trial[J]. Lancet, 2022, 399 (10335): 1607-17. doi: 10.1016/S0140-6736(21)02333-3 [24] 杨兴玲, 王晓伟, 金海. 非小细胞肺癌的外科治疗之全肺切除术[J]. 中华胸心血管外科杂志, 2020, 36(11): 694-700. doi: 10.3760/cma.j.cn112434-20191030-00383 [25] 左正琴, 许志刚, 程春霞, 等. 床旁超声在肺癌切除术后心功能评估及肺部并发症诊治中的应用研究[J]. 临床肺科杂志, 2021, 26(9): 1420-4. doi: 10.3969/j.issn.1009-6663.2021.09.027 [26] Kolashov A, Lotfi S, Spillner J, et al. Evaluation of myocardial work changes after lung resection-the significance of surgical approach: an echocardiographic comparison between VATS and thoracotomy[J]. Gen Thorac Cardiovasc Surg, 2024, 72(8): 542-50. doi: 10.1007/s11748-023-02005-7 [27] 贾咏梅, 付义敏, 赵华. 心脏彩超测定Tei指数用于胸腔镜下与开胸肺叶切除术后心肌功能的临床评估[J]. 海南医学院学报, 2016, 22 (5): 499-502. [28] Maaliki N, Verdecia J, Fasen M, et al. Accelerated right heart failure due to lung resection in the setting of chronic respiratory failure[J]. J Cardiol Cases, 2022, 25(1): 42-5. doi: 10.1016/j.jccase.2021.06.007 [29] Koshino Y, Villarraga HR, Orban M, et al. Changes in left and right ventricular mechanics during the Mueller maneuver in healthy adults: a possible mechanism for abnormal cardiac function in patients with obstructive sleep apnea[J]. Circ Cardiovasc Imaging, 2010, 3(3): 282-9. doi: 10.1161/CIRCIMAGING.109.901561 [30] Wei X, Yu HF, Dai W, et al. Patient-reported outcomes of video-assisted thoracoscopic surgery versus thoracotomy for locally advanced lung cancer: a longitudinal cohort study[J]. Ann Surg Oncol, 2021, 28(13): 8358-71. doi: 10.1245/s10434-021-09981-1 [31] Homma T, Shimada Y, Tanabe K. Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video- assisted thoracoscopic anatomical lung resection: a single- center initial experience of 100 cases[J]. J Thorac Dis, 2022, 14(9): 3154-66. doi: 10.21037/jtd-22-6 -
点击查看大图
图(1) / 表(4)
计量
- 文章访问数: 31
- HTML全文浏览量: 9
- PDF下载量: 2
- 被引次数: 0
