Forfia Paul R, Fisher Micah R, Mathai Stephen C, Housten-Harris Traci, Hemnes Anna R, Borlaug Barry A, Chamera Elzbieta, Corretti Mary C, Champion Hunter C, Abraham Theodore P, Girgis Reda E, Hassoun Paul M
Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Asthma & Allergy Center, Baltimore, MD 21224, USA.
Am J Respir Crit Care Med. 2006 Nov 1;174(9):1034-41. doi: 10.1164/rccm.200604-547OC. Epub 2006 Aug 3.
Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV function is often limited by complex geometry and poor endocardial definition.
To test whether the degree of tricuspid annular displacement (tricuspid annular plane systolic excursion [TAPSE]) is a useful echo-derived measure of RV function with prognostic significance in pulmonary hypertension.
We prospectively studied 63 consecutive patients with pulmonary hypertension who were referred for a clinically indicated right heart catheterization. Patients underwent right heart catheterization immediately followed by transthoracic echocardiogram and TAPSE measurement.
In the overall cohort, a TAPSE of less than 1.8 cm was associated with greater RV systolic dysfunction (cardiac index, 1.9 vs. 2.7 L/min/m2; RV % area change, 24 vs. 33%), right heart remodeling (right atrial area index, 17.0 vs. 12.1 cm(2)/m), and RV-left ventricular (LV) disproportion (RV/LV diastolic area, 1.7 vs. 1.2; all p < 0.001), versus a TAPSE of 1.8 cm or greater. In patients with pulmonary arterial hypertension (PAH; n = 47), survival estimates at 1 and 2 yr were 94 and 88%, respectively, in those with a TAPSE of 1.8 cm or greater versus 60 and 50%, respectively, in subjects with a TAPSE less than 1.8 cm. The unadjusted risk of death (hazard ratio) in patients with a TAPSE less than 1.8 versus 1.8 cm or greater was 5.7 (95% confidence interval, 1.3-24.9; p = 0.02) for the PAH cohort. For every 1-mm decrease in TAPSE, the unadjusted risk of death increased by 17% (hazard ratio, 1.17; 95% confidence interval, 1.05-1.30; p = 0.006), which persisted after adjusting for other echocardiographic and hemodynamic variables and baseline treatment status.
TAPSE powerfully reflects RV function and prognosis in PAH.
右心室（RV）功能是肺动脉高压预后的重要决定因素。然而，右心室功能的无创评估常常受到其复杂的几何形状和心内膜定义不佳的限制。
测试三尖瓣环位移程度（三尖瓣环平面收缩期位移 [TAPSE]）是否是一种通过超声心动图得出的、对肺动脉高压患者右心室功能具有预后意义的有用测量指标。
我们前瞻性地研究了63例因临床需要接受右心导管检查的连续肺动脉高压患者。患者在接受右心导管检查后立即进行经胸超声心动图检查并测量TAPSE。
在整个队列中，与TAPSE≥1.8 cm的患者相比，TAPSE＜1.8 cm的患者右心室收缩功能障碍更严重（心脏指数，1.9 vs. 2.7 L/min/m²；右心室面积变化百分比，24% vs. 33%），右心重塑更明显（右心房面积指数，17.0 vs. 12.1 cm²/m），右心室-左心室（LV）比例失调更严重（右心室/左心室舒张期面积，1.7 vs. 1.2；所有p＜0.001）。在肺动脉高压（PAH；n = 47）患者中，TAPSE≥1.8 cm的患者1年和2年生存率估计分别为94%和88%，而TAPSE＜1.8 cm的患者分别为60%和50%。在PAH队列中，TAPSE＜1.8 cm与TAPSE≥1.8 cm的患者相比，未调整的死亡风险（风险比）为5.7（95%置信区间，1.3 - 24.9；p = 0.02）。TAPSE每降低1 mm，未调整的死亡风险增加17%（风险比，1.17；95%置信区间，1.05 - 1.30；p = 0.006），在调整其他超声心动图和血流动力学变量以及基线治疗状态后，该结果依然存在。
TAPSE有力地反映了PAH患者的右心室功能和预后。
