Meluzin Jaroslav, Spinarová Lenka, Hude Petr, Krejcí Jan, Kincl Vladimír, Panovský Roman, Dusek Ladislav
Department of Internal Medicine and the Centere of Biostatics and Analyses, Masaryk University, Brno, Czech Republic.
J Am Soc Echocardiogr. 2005 May;18(5):435-44. doi: 10.1016/j.echo.2005.02.004.
Little is known about the prognostic importance of right ventricular (RV) systolic and diastolic function. The purpose of this study was to determine the prognostic power of systolic and diastolic RV functional parameters derived from Doppler tissue imaging of tricuspid annular motion and to assess whether their combination might improve the risk stratification of patients with heart failure. In all, 140 patients with symptomatic heart failure and left ventricular ejection fraction of 40% or less underwent standard echocardiography, Doppler tissue imaging of tricuspid annular motion, and right heart catheterization. They were followed up for a mean period of 17 months for cardiac-related death and nonfatal cardiac events including the implantation of cardioverter-defibrillator and hospitalization for heart failure decompensation. A total of 48 cardiac events occurred; 19 patients died, 26 were hospitalized for heart failure decompensation, and 3 because of the need for implantation of a cardioverter-defibrillator. The peak tricuspid annular velocity during systolic ejection of 10.8 cm/s or less, peak early diastolic tricuspid annular velocity of 8.9 cm/s or less, tricuspid annular acceleration during isovolumic contraction of 2.52 m/s 2 or less, and Doppler RV index (Tei index) of 1.20 or more were found to significantly worsen survival or event-free survival. However, their combination significantly exceeded the predictive potential of individual parameters. The worst survival was predicted by the combination of peak tricuspid annular velocity during systolic ejection of 10.8 cm/s or less plus peak early diastolic tricuspid annular velocity of 8.9 cm/s or less plus tricuspid annular acceleration during isovolumic contraction of 2.52 m/s 2 or less (relative risk 6.17, P < .001), whereas the worst event-free survival was identified by the combination of peak tricuspid annular velocity during systolic ejection of 10.8 cm/s or less plus peak early diastolic tricuspid annular velocity of 8.9 cm/s or less plus Doppler RV index (Tei index) of 1.20 or more (relative risk 3.62, P < .001). In conclusion, the combination of RV systolic and diastolic functional parameters represents a very powerful tool for risk stratification of patients with symptomatic heart failure.
关于右心室（RV）收缩和舒张功能的预后重要性，人们了解甚少。本研究的目的是确定源自三尖瓣环运动的多普勒组织成像的收缩和舒张期RV功能参数的预后能力，并评估它们的组合是否可以改善心力衰竭患者的风险分层。总共140例有症状心力衰竭且左心室射血分数为40%或更低的患者接受了标准超声心动图、三尖瓣环运动的多普勒组织成像和右心导管检查。他们平均随访17个月，观察心脏相关死亡和非致命性心脏事件，包括植入心脏复律除颤器和因心力衰竭失代偿住院。共发生48例心脏事件；19例患者死亡，26例因心力衰竭失代偿住院，3例因需要植入心脏复律除颤器住院。发现收缩期射血时三尖瓣环峰值速度小于或等于10.8 cm/s、舒张早期三尖瓣环峰值速度小于或等于8.9 cm/s、等容收缩期三尖瓣环加速度小于或等于2.52 m/s²以及多普勒RV指数（Tei指数）大于或等于1.20会显著恶化生存率或无事件生存率。然而，它们的组合显著超过了单个参数的预测潜力。收缩期射血时三尖瓣环峰值速度小于或等于10.8 cm/s加上舒张早期三尖瓣环峰值速度小于或等于8.9 cm/s加上等容收缩期三尖瓣环加速度小于或等于2.52 m/s²的组合预测最差生存率（相对风险6.17，P <.001），而收缩期射血时三尖瓣环峰值速度小于或等于10.8 cm/s加上舒张早期三尖瓣环峰值速度小于或等于8.9 cm/s加上多普勒RV指数（Tei指数）大于或等于1.20的组合确定最差无事件生存率（相对风险3.62，P <.001）。总之，RV收缩和舒张功能参数的组合是有症状心力衰竭患者风险分层的非常有力的工具。
