PDF(Pubmed)
Abstract：
BACKGROUND: The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation. RV free wall longitudinal strain (RVFWLS) has been reported to detect RV systolic dysfunction earlier than other conventional parameters. Although pulmonary artery systolic pressure measured by Doppler echocardiography is often underestimated in severe functional tricuspid regurgitation, right atrial pressure (RAP) estimated by echocardiography may be viewed as a prognostic factor. Impact of RAP and RVFWLS on outcome in patients with severe functional tricuspid regurgitation remains unclear. The aim of the present study was to investigate prognostic implication of RAP, RVFWLS, and their combination in this population.
RESULTS: We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All-cause death at 2-year follow-up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all-cause death than those without by Kaplan-Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome.
CONCLUSIONS: Elevated RAP and RVFWLS of ≤18% were independent predictors of all-cause death. The combination of elevated RAP and RVFWLS effectively stratified the all-cause death.
RESULTS: We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All-cause death at 2-year follow-up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all-cause death than those without by Kaplan-Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome.
CONCLUSIONS: Elevated RAP and RVFWLS of ≤18% were independent predictors of all-cause death. The combination of elevated RAP and RVFWLS effectively stratified the all-cause death.
摘要：
背景：右心室（RV）功能与肺动脉高压之间的相互作用对于重度功能性三尖瓣反流患者的预后至关重要。据报道，RV游离壁纵向应变（RVFWLS）比其他常规参数更早地检测RV收缩功能障碍。尽管通过多普勒超声心动图测量的肺动脉收缩压在严重的功能性三尖瓣反流中通常被低估，超声心动图评估的右心房压(RAP)可作为预后因素.RAP和RVFWLS对重度功能性三尖瓣反流患者预后的影响尚不清楚。本研究的目的是探讨RAP的预后意义，RVFWLS,以及他们在这个人群中的组合。
结果：我们回顾性检查了377例严重功能性三尖瓣反流患者。RAP,肺动脉收缩压,RV分数面积变化，和RVFWLS进行分析。15mmHg的RAP被分类为升高的RAP。2年随访时的全因死亡被定义为主要终点。通过受试者工作特征曲线分析，RVFWLS比RV面积变化提供了更好的预后信息。在多变量Cox回归分析中，RAP升高和RVFWLS≤18%是临床结局的独立预测因子.通过Kaplan-Meier曲线分析，RVFWLS≤18％的患者比没有RVFWLS的患者具有更高的全因死亡风险。此外，当通过RAP和RVFWLS将患者分为4组时，RAP升高且RVFWLS≤18%的组的结局最差.
结论：RAP升高和RVFWLS≤18%是全因死亡的独立预测因子。升高的RAP和RVFWLS的组合有效地将全因死亡分层。
结果：我们回顾性检查了377例严重功能性三尖瓣反流患者。RAP,肺动脉收缩压,RV分数面积变化，和RVFWLS进行分析。15mmHg的RAP被分类为升高的RAP。2年随访时的全因死亡被定义为主要终点。通过受试者工作特征曲线分析，RVFWLS比RV面积变化提供了更好的预后信息。在多变量Cox回归分析中，RAP升高和RVFWLS≤18%是临床结局的独立预测因子.通过Kaplan-Meier曲线分析，RVFWLS≤18％的患者比没有RVFWLS的患者具有更高的全因死亡风险。此外，当通过RAP和RVFWLS将患者分为4组时，RAP升高且RVFWLS≤18%的组的结局最差.
结论：RAP升高和RVFWLS≤18%是全因死亡的独立预测因子。升高的RAP和RVFWLS的组合有效地将全因死亡分层。
