Dini Frank Lloyd, Conti Umberto, Fontanive Paolo, Andreini Diana, Banti Stefano, Braccini Lara, De Tommasi Salvatore Mario
Unità Malattie Cardiovascolari 2, Santa Chiara Hospital, Pisa, Italy.
Am Heart J. 2007 Jul;154(1):172-9. doi: 10.1016/j.ahj.2007.03.033.
This study aimed to assess the prognostic value of right ventricular (RV) dysfunction in patients with secondary mitral regurgitation (MR) by simple methods of echocardiographic measurement. Although both RV dysfunction and functional MR may affect prognosis of patients with heart failure (HF) due to left ventricular (LV) dysfunction, information is lacking regarding the impact of RV dysfunction in patients with functional MR.
Among 356 consecutive patients with chronic HF due to LV dysfunction (ejection fraction < or = 45%), 107 met the entry criteria of moderate to severe MR as assessed by a vena contracta width > or = 0.5 cm. Tricuspid annular plane systolic excursion (TAPSE) was acquired to evaluate RV function. Median follow-up duration was 21 months.
Among patients with a vena contracta width > or = 0.5 cm, 30 (28%) died and 28 (26%) were hospitalized for worsening HF. By multivariate analysis, TAPSE < or = 14 mm (hazard ratio [HR] 2.83, P = .027) and LV ejection fraction (HR 2.17, P = .099) were predictive of death from all causes. Independent predictors of freedom from all-cause mortality or hospitalization for worsening HF were New York Heart Association class (HR 2.15, P = .027), age (HR 1.98, P = .021) and TAPSE < or = 14 mm (HR 1.96, P = .031). At 24 months, survival was 45% in those with the worse TAPSE, whereas it was 82% in those with TAPSE > 14 mm (log-rank statistic = 0.0002). Aminoterminal pro-type B natriuretic peptide plasma levels were higher in patients with vena contracta width of > or = 0.5 cm and TAPSE < or = 14 mm.
This study shows that RV function, assessed by TAPSE, plays a major role in the outcome of patients with functional moderate to severe MR.
本研究旨在通过超声心动图测量的简单方法评估继发性二尖瓣反流（MR）患者右心室（RV）功能障碍的预后价值。尽管RV功能障碍和功能性MR均可能影响因左心室（LV）功能障碍导致的心力衰竭（HF）患者的预后，但关于RV功能障碍对功能性MR患者的影响的信息尚缺乏。
在356例因LV功能障碍（射血分数≤45%）导致的慢性HF连续患者中，107例经评估符合中度至重度MR的纳入标准，即缩流颈宽度≥0.5 cm。获取三尖瓣环平面收缩期位移（TAPSE）以评估RV功能。中位随访时间为21个月。
在缩流颈宽度≥0.5 cm的患者中，30例（28%）死亡，28例（26%）因HF恶化住院。通过多变量分析，TAPSE≤14 mm（风险比[HR] 2.83，P = 0.027）和LV射血分数（HR 2.17，P = 0.099）可预测全因死亡。无全因死亡或因HF恶化住院的独立预测因素为纽约心脏协会分级（HR 2.15，P = 0.027）、年龄（HR 1.98，P = 0.021）和TAPSE≤14 mm（HR 1.96，P = 0.031）。在24个月时，TAPSE较差的患者生存率为45%，而TAPSE>14 mm的患者生存率为82%（对数秩检验统计量=0.0002）。缩流颈宽度≥0.5 cm且TAPSE≤14 mm的患者氨基末端B型利钠肽原血浆水平较高。
本研究表明，通过TAPSE评估的RV功能在功能性中度至重度MR患者的预后中起主要作用。
