Emory University School of Medicine, Atlanta, GA, USA.
J Am Soc Echocardiogr. 2012 Mar;25(3):304-12. doi: 10.1016/j.echo.2011.12.003. Epub 2011 Dec 23.
The prognostic value of deformation parameters of the systemic right ventricle in adults with D-transposition of the great arteries and prior atrial switch has not been reported.
Sixty-four adults with D-transposition of the great arteries and prior atrial switch (mean age, 29 ± 6 years; 22 women; mean right ventricular [RV] fractional area change, 22.9 ± 7.5%; 31 with pacemakers at baseline) and no histories of heart failure or ventricular tachycardia were prospectively evaluated. Global longitudinal strain (GS), global systolic strain rate (GSRs), and global early diastolic strain rate (GSRe) of the right ventricle were measured using speckle tracking from apical views and compared with standard parameters of RV function (fractional area change, tricuspid annular plane systolic excursion, tissue Doppler velocities, and isovolumic acceleration) for association with and potential prediction of clinical events, defined as incident stage C heart failure or ventricular tachycardia.
Baseline RV GS, GSRs, and GSRe were -12.5 ± 3.0%, -0.59 ± 0.14 sec(-1), and 0.68 ± 0.22 sec(-1), respectively. After a median of 2.4 years (interquartile range, 1.5-4.1 years), 12 patients (19%) presented with clinical events (heart failure in 11 patients, ventricular tachycardia in one patient). In Cox models, RV GS had the strongest association with clinical events (hazard ratio [HR] per 1%, 1.35; 95% confidence interval [CI], 1.14-1.58; P < .001), followed by GSRs (HR per 0.01 sec(-1), 1.06; 95% CI, 1.02-1.11; P = .006), GSRe (HR per -0.01 sec(-1), 1.04; 95% CI, 1.00-1.07; P = .031), and fractional area change (HR per -1%, 1.08; 95% CI, 1.00-1.17; P = .047). Other measures of RV function were not significantly associated with risk for events. In receiver operating characteristic analysis, RV GS ≥ -10% optimally predicted future events (C = 0.83; 95% CI, 0.71-0.91; P < .001).
Reduced longitudinal GS of the systemic right ventricle is associated with increased risk for clinical events among patients with D-transposition of the great arteries and prior atrial switch.
在患有 D 型大动脉转位和先前心房切换术的成年人中，系统性右心室变形参数的预后价值尚未得到报道。
前瞻性评估了 64 名患有 D 型大动脉转位和先前心房切换术的成年人（平均年龄 29±6 岁；22 名女性；平均右心室[RV]分数面积变化 22.9±7.5%；31 名患者基线时有起搏器），且无心力衰竭或室性心动过速病史。使用斑点追踪法从心尖视图测量右心室的整体纵向应变（GS）、整体收缩期应变率（GSRs）和整体早期舒张应变率（GSRe），并将其与 RV 功能的标准参数（分数面积变化、三尖瓣环平面收缩期位移、组织多普勒速度和等容加速度）进行比较，以评估与临床事件的相关性，并预测临床事件，定义为新发 C 期心力衰竭或室性心动过速。
基线时 RV GS、GSRs 和 GSRe 分别为-12.5±3.0%、-0.59±0.14 sec(-1)和 0.68±0.22 sec(-1)。中位数为 2.4 年（四分位距，1.5-4.1 年）后，12 名患者（19%）出现临床事件（11 名患者心力衰竭，1 名患者室性心动过速）。在 Cox 模型中，RV GS 与临床事件的相关性最强（每增加 1%的 HR，1.35；95%置信区间[CI]，1.14-1.58；P<.001），其次是 GSRs（每增加 0.01 sec(-1)的 HR，1.06；95%CI，1.02-1.11；P=.006）、GSRe（每减少 0.01 sec(-1)的 HR，1.04；95%CI，1.00-1.07；P=.031）和分数面积变化（每减少 1%的 HR，1.08；95%CI，1.00-1.17；P=.047）。RV 功能的其他测量指标与事件风险无显著相关性。在受试者工作特征分析中，RV GS≥-10% 可最佳预测未来事件（C=0.83；95%CI，0.71-0.91；P<.001）。
在患有 D 型大动脉转位和先前心房切换术的患者中，系统性右心室的纵向 GS 降低与临床事件风险增加相关。
