Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
Circ Heart Fail. 2010 May;3(3):340-6. doi: 10.1161/CIRCHEARTFAILURE.109.900134. Epub 2010 Feb 22.
Right ventricular (RV) systolic dysfunction is a strong predictor of adverse outcomes in heart failure, yet quantitatively assessing the impact of therapy on this condition is difficult. Our objective was to compare the clinical significance of changes in RV echocardiographic indices in response to intensive medical treatment in patients admitted to the hospital with acute decompensated heart failure (ADHF).
Serial comprehensive echocardiography was performed in 62 consecutive patients with ADHF, and adverse events (death, cardiac transplantation, assist device, heart failure rehospitalization) were prospectively documented. RV peak systolic strain was assessed using speckle-tracking longitudinal strain analysis as the average of the basal, mid-, and apical segment of the RV free wall. Other conventional parameters of RV function (RV fractional area change, RV myocardial performance index, tricuspid annular peak systolic excursion, and tissue Doppler peak tricuspid annular systolic velocity) were measured for comparison. In our study cohort [left ventricular ejection fraction, 26+/-10%; cardiac index, 2.0+/-0.6 L/(min . m(2))], overall mean RV peak systolic strain was -14+/-4% at baseline and -15+/-4% at 48 to 72 hours (P=0.27). Among all the RV functional indices measured, only RV peak systolic strain at 48 to 72 hours was associated with adverse events (P=0.02). In particular, improvement in RV peak systolic strain after intensive medical treatment was associated with lower adverse events in this patient population (26% versus 78%; hazard ratio, 0.13; 95% CI, 0.02 to 0.84; P=0.02).
Dynamic improvement in RV mechanics in response to intensive medical therapy was associated with lower long-term adverse events in patients with ADHF than in patients not showing improvement.
右心室（RV）收缩功能障碍是心力衰竭不良预后的强有力预测因子，但定量评估治疗对该疾病的影响较为困难。我们的目的是比较急性失代偿性心力衰竭（ADHF）住院患者强化药物治疗后 RV 超声心动图指标变化的临床意义。
对 62 例连续 ADHF 患者进行了系列综合超声心动图检查，并前瞻性记录了不良事件（死亡、心脏移植、辅助装置、心力衰竭再入院）。使用斑点追踪纵向应变分析评估 RV 收缩期峰值应变，作为 RV 游离壁基底、中部和顶部节段的平均值。为了进行比较，还测量了其他常规 RV 功能参数（RV 节段性面积变化、RV 心肌运动指数、三尖瓣环收缩期峰值位移和组织多普勒峰三尖瓣环收缩速度）。在我们的研究队列中（左心室射血分数，26±10%；心指数，2.0±0.6 L/（min. m(2)）），整体平均 RV 收缩期峰值应变在基线时为-14±4%，在 48 至 72 小时时为-15±4%（P=0.27）。在所有测量的 RV 功能指标中，只有 RV 收缩期峰值应变在 48 至 72 小时时与不良事件相关（P=0.02）。特别是，强化药物治疗后 RV 收缩期峰值应变的改善与该患者人群的较低不良事件相关（26%比 78%；危险比，0.13；95%置信区间，0.02 至 0.84；P=0.02）。
与未显示改善的患者相比，ADHF 患者强化药物治疗后 RV 力学的动态改善与较低的长期不良事件相关。
