背景:有证据表明右心室(RV)收缩功能,尤其是它与肺循环的耦合,对左心室功能不全患者具有重要的预后价值。
目的:本研究旨在单独或以右心室-肺动脉耦合指数(RV-PA耦合)的形式确定RV功能和肺动脉收缩压(PASP)的最佳超声心动图参数,以确定1年主要不良心血管事件(MACE)的最佳预测因子,这被定义为心血管死亡和心脏代偿失调的心力衰竭患者射血分数降低(HFrEF)。
结果:该研究纳入了191名HFrEF患者(平均年龄62.28±12.79岁,74%的男性,平均左心室射血分数(LVEF)25.53±6.87%)。所有患者都接受了临床,实验室,和经胸超声心动图(TTE)评估,重点评估RV-PA耦合的RV功能和非侵入性参数。使用分数面积变化(FAC)评估RV功能,三尖瓣环平面收缩期偏移(TAPSE),和三尖瓣环收缩期峰值速度(TAS)。PASP通过三尖瓣反流峰值速度(TRVmax)估算,并通过相对于下腔静脉的尺寸和塌陷性的假定右心房压力进行校正。将TAPSE/PASP和TAS/PASP比率作为RV-PA偶联的指标。随访期间(平均340±84天),58.1%的患者达到复合终点。一年结局的独立预测因素显示为高龄,心房颤动,左心房收缩期容积(LAVI),LVEF,TAPSE/PASP,和TAS/PASP。TAS/PASP是预后最强的独立预测因子,危险比(HR)为0.67(0.531-0.840),p<0.001。重建ROC曲线0.8(0.723-0.859),p<0.001,我们获得了TAS/PASP≤0.19(cm/s/mmHg)的阈值(敏感性74.0,特异性75.2)。TAS/RVSP≤0.19的患者预后较差(LogRankp<0.001)。
结论:这项研究证实了先前已知的HfrEF高龄患者不良结局的独立预测因子,心房颤动,LAVI,和LVEF-但RV-PA偶联TAPSE/PASP和TAS\'/PASP的非侵入性参数改善了HFrEF患者的风险分层。变量TAS\'/PASP已被证明是最强大的,一年结局的独立预测因子。
BACKGROUND: There is evidence that right ventricular (RV) contractile function, especially its
coupling with the pulmonary circulation, has an important prognostic value in patients with left ventricular dysfunction.
OBJECTIVE: This study aimed to identify the best echocardiographic parameters of RV function and pulmonary artery systolic pressure (PASP) alone or in the form of the index of right ventricular-pulmonary artery
coupling (RV-PA
coupling) to determine the best predictor of 1-year major adverse cardiovascular events (MACE), which were defined as cardiovascular death and cardiac decompensation in heart failure patients with reduced ejection fraction (HFrEF).
RESULTS: The study enrolled 191 HFrEF patients (mean age 62.28 ± 12.79 years, 74% males, mean left ventricular ejection fraction (LVEF) 25.53 ± 6.87%). All patients underwent clinical, laboratory, and transthoracic echocardiographic (TTE) evaluation, focusing on assessing RV function and non-invasive parameters of RV-PA
coupling. RV function was evaluated using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and peak tricuspid annular systolic velocity (TAS\'). PASP was estimated by peak tricuspid regurgitation velocity (TRVmax) and corrected by assumed right atrial pressure relative to the dimension and collapsibility of the inferior vena cava. The TAPSE/PASP and TAS\'/PASP ratios were taken as an index of RV-PA
coupling. During the follow-up (mean period of 340 ± 84 days), 58.1% of patients met the composite endpoint. The independent predictors of one-year outcome were shown to be advanced age, atrial fibrillation, indexed left atrial systolic volume (LAVI), LVEF, TAPSE/PASP, and TAS\'/PASP. TAS\'/PASP emerged as the strongest independent predictor of prognosis, with a hazard ratio (HR) of 0.67 (0.531-0.840), p < 0.001. Reconstructing the ROC curve 0.8 (0.723-0.859), p < 0.001, we obtained a threshold value of TAS\'/PASP ≤ 0.19 (cm/s/mm Hg) (sensitivity 74.0, specificity 75.2). Patients with TAS\'/RVSP ≤ 0.19 have a worse prognosis (Log Rank p < 0.001).
CONCLUSIONS: This study confirmed previously known independent predictors of adverse outcomes in patients with HfrEF-advanced age, atrial fibrillation, LAVI, and LVEF-but non-invasive parameters of RV-PA coupling TAPSE/PASP and TAS\'/PASP improved risk stratification in patients with HFrEF. Variable TAS\'/PASP has been shown to be the most powerful, independent predictor of one-year outcome.