Abstract：
OBJECTIVE: To assess right heart diastolic energy loss (EL) as a cardiac workload and evaluate its association with major cardiac events (MACE) in adult patients with pulmonary atresia with an intact ventricular septum (PAIVS).
METHODS: We retrospectively enrolled and compared 30 consecutive adult patients (18 with PAIVS and 12 with pulmonary stenosis [PS] as controls) who underwent right ventricular (RV) outflow tract reconstruction and 4D flow MRI. EL, conventional parameters on MRI, and the severity of tricuspid regurgitation (TR) on echocardiography were assessed. We also evaluated the association between MACE including arrhythmias, heart failure, surgical intervention, and imaging parameters in adults with PAIVS.
RESULTS: Patients with PAIVS were younger, had a higher diastolic EL/cardiac output (CO) ratio, and had a more significant TR than those with PS (controls). However, RV volume, ejection fraction (EF), and pulmonary regurgitation (PR) severity did not differ between the two groups. Higher RV end-diastolic pressure (EDP) and lower cardiac index (CI) correlated with the diastolic EL/CO in patients with PAIVS. Univariate logistic analysis demonstrated that older age and a higher diastolic EL/CO ratio were important factors for MACE in adults with PAIVS (P = 0.048, 0.049).
CONCLUSIONS: A higher diastolic EL/CO ratio was associated with a higher RV EDP and lower CI. A high diastolic EL/CO ratio is also associated with MACE in adults with PAIVS. Even in adults with normal RV volume and EF, the right heart EL was elevated, suggesting an excessive right-sided cardiac workload that integrated both afterload and preload beyond the RV size in adult patients with PAIVS.
METHODS: We retrospectively enrolled and compared 30 consecutive adult patients (18 with PAIVS and 12 with pulmonary stenosis [PS] as controls) who underwent right ventricular (RV) outflow tract reconstruction and 4D flow MRI. EL, conventional parameters on MRI, and the severity of tricuspid regurgitation (TR) on echocardiography were assessed. We also evaluated the association between MACE including arrhythmias, heart failure, surgical intervention, and imaging parameters in adults with PAIVS.
RESULTS: Patients with PAIVS were younger, had a higher diastolic EL/cardiac output (CO) ratio, and had a more significant TR than those with PS (controls). However, RV volume, ejection fraction (EF), and pulmonary regurgitation (PR) severity did not differ between the two groups. Higher RV end-diastolic pressure (EDP) and lower cardiac index (CI) correlated with the diastolic EL/CO in patients with PAIVS. Univariate logistic analysis demonstrated that older age and a higher diastolic EL/CO ratio were important factors for MACE in adults with PAIVS (P = 0.048, 0.049).
CONCLUSIONS: A higher diastolic EL/CO ratio was associated with a higher RV EDP and lower CI. A high diastolic EL/CO ratio is also associated with MACE in adults with PAIVS. Even in adults with normal RV volume and EF, the right heart EL was elevated, suggesting an excessive right-sided cardiac workload that integrated both afterload and preload beyond the RV size in adult patients with PAIVS.
摘要：
目的：评估右心舒张能量损失（EL）作为心脏负荷，并评估其与室间隔完整（PAIVS）的成年肺动脉闭锁患者的主要心脏事件（MACE）的关系。
方法：我们回顾性纳入并比较了30例接受右心室（RV）流出道重建和4D血流MRI的连续成年患者（18例PAIVS和12例肺动脉狭窄[PS]作为对照）。EL,MRI上的常规参数，并在超声心动图上评估三尖瓣返流（TR）的严重程度。我们还评估了包括心律失常在内的MACE之间的关联，心力衰竭,手术干预,和成人PAIVS的成像参数。
结果：PAIVS患者更年轻，具有较高的舒张期EL/心输出量（CO）比率，并且具有比PS（对照）更显著的TR。然而,RV音量,射血分数（EF），肺反流（PR）严重程度两组间无差异。在PAIVS患者中，较高的RV舒张末期压（EDP）和较低的心脏指数（CI）与舒张期EL/CO相关。单因素logistic分析显示，年龄较大和舒张期EL/CO比值较高是PAIVS患者发生MACE的重要因素（P=0.048、0.049）。
结论：较高的舒张期EL/CO比值与较高的RVEDP和较低的CI相关。在患有PAIVS的成人中,高舒张期EL/CO比率也与MACE相关。即使在RV容量和EF正常的成年人中，右心EL升高，提示在患有PAIVS的成年患者中,右侧过度的心脏工作负荷将后负荷和前负荷结合在RV大小之外。
方法：我们回顾性纳入并比较了30例接受右心室（RV）流出道重建和4D血流MRI的连续成年患者（18例PAIVS和12例肺动脉狭窄[PS]作为对照）。EL,MRI上的常规参数，并在超声心动图上评估三尖瓣返流（TR）的严重程度。我们还评估了包括心律失常在内的MACE之间的关联，心力衰竭,手术干预,和成人PAIVS的成像参数。
结果：PAIVS患者更年轻，具有较高的舒张期EL/心输出量（CO）比率，并且具有比PS（对照）更显著的TR。然而,RV音量,射血分数（EF），肺反流（PR）严重程度两组间无差异。在PAIVS患者中，较高的RV舒张末期压（EDP）和较低的心脏指数（CI）与舒张期EL/CO相关。单因素logistic分析显示，年龄较大和舒张期EL/CO比值较高是PAIVS患者发生MACE的重要因素（P=0.048、0.049）。
结论：较高的舒张期EL/CO比值与较高的RVEDP和较低的CI相关。在患有PAIVS的成人中,高舒张期EL/CO比率也与MACE相关。即使在RV容量和EF正常的成年人中，右心EL升高，提示在患有PAIVS的成年患者中,右侧过度的心脏工作负荷将后负荷和前负荷结合在RV大小之外。
