目标:评估右心功能具有挑战性,特别是当存在显著的三尖瓣反流(TR)时。在可用的超声心动图评估技术中,文献表明,应变成像可能更可靠,不易受载荷条件的影响。因此,我们旨在评估RA和RV菌株相对于常规指标的有效性,以及它们在预测TR患者结局方面的效用.
方法:我们研究了262名连续患者(平均年龄74±11.2岁,53%的男性),在2018年至2023年期间接受了同一天超声心动图和右心导管检查。我们将右心劳损与传统的RV功能指标进行了比较,随后将RA和RV劳损与心力衰竭(HF)相关的死亡或住院相关联。以先到者为准。
结果:平均随访34±15个月,有103例死亡和HF住院治疗.RA和RV应变均与超声心动图和右心功能的侵入性测量相关。在所有患者中,保留的RA菌株与较低的不良结局风险相关(HR0.763,95%CI0.618-0.943).同样,保留的RV菌株与更好的结果相关,尽管这仅在无严重TR或肺动脉高压的患者中具有统计学意义(HR2.450,95%CI1.244-4.825)。此外,RV应变与肺压的异常比率和RV大小与不良结局显著相关(各p<0.05).
结论:RA和RV应变与超声心动图和心脏功能的侵入性测量独立相关。此外,保留的RA和RV菌株可能与更好的临床结局相关.
OBJECTIVE: Assessing right heart function is challenging, particularly when significant tricuspid regurgitation (TR) is present. Among available echocardiographic techniques for assessment, literatures suggests that strain imaging may be more reliable and less susceptible to loading conditions. Thus, we aimed to assess the validity of RA and RV strain relative to conventional metrics as well as their utility in predicting patient outcomes in TR.
METHODS: We studied 262 consecutive patients (mean age 74 ± 11.2 years, 53% male) who underwent same-day echocardiography and right heart catheterization between 2018 and 2023. We compared right heart strain to traditional metrics of RV function and subsequently correlated RA and RV strain to heart failure (HF)-related death or hospitalization, whichever came first.
RESULTS: Over a mean follow-up of 34 ± 15 months, there were 103 deaths and HF hospitalizations. Both RA and RV strain were correlated with echocardiographic and invasive measures of right heart function. Across all patients, preserved RA strain was associated with lower risk of adverse outcomes (HR 0.763, 95% CI 0.618-0.943). Similarly, preserved RV strain was correlated with better outcomes, though this was only statistically significant in patients without severe TR or pulmonary hypertension (HR 2.450, 95% CI 1.244-4.825). Moreover, abnormal ratios of RV strain to pulmonary pressures and RV size were significantly correlated with adverse outcomes (p < 0.05 each).
CONCLUSIONS: RA and RV strain are independently correlated with echocardiographic and invasive measures of cardiac function. Moreover, preserved RA and RV strain are likely associated with better clinical outcomes.