Service de Cardiologie, Pôle Cardio-Vasculaire et Pulmonaire, Hôpital Cardiologique, Boul Prof J Leclercq, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
Eur Heart J. 2012 Nov;33(21):2672-9. doi: 10.1093/eurheartj/ehs080. Epub 2012 Mar 27.
Previous studies have demonstrated that the radionuclide right ventricular (RV) ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler peak systolic tricuspid annular velocity (STr) were independent predictors of cardiac survival in stable patients with left ventricular systolic dysfunction (LVSD). No study has compared the prognostic value of these three RV parameters. The aim of this study was to compare the prognostic value of RVEF, TAPSE, and STr in a large group of patients with LVSD.
We analysed 527 consecutive patients who underwent an extensive prognostic evaluation (clinical data, biological data, radionuclide angiography, echoDopplercardiography, cardiopulmonary exercise test). Tricuspid annular plane systolic excursion and STr were weakly correlated with RVEF (r = 0.20). During a follow-up period of 1268 days (802-1830), there were 121 cardiovascular deaths. Best cut-off values were 37%, 9.7 cm/s, and 18.5 mm for RVEF, STr, and TAPSE, respectively. Right ventricular ejection fraction was a powerful independent predictor of cardiac survival [relative risk (RR): 2.05 (1.29-3.26), P = 0.002]. Peak systolic tricuspid annular velocity added a modest prognostic information [RR: 1.56 (1.02-2.39), P = 0.04]. However, the combination of STr with RVEF was the most powerful predictor of cardiovascular death. Tricuspid annular plane systolic excursion was not an independent predictor of cardiac survival.
Right ventricular systolic function remains a powerful independent predictor of the clinical outcome. Even in the context of a complete echocardiographic assessment, radionuclide RVEF continues to be the most powerful RV systolic parameter for cardiac survival prediction. However, the determination of STr, in addition to RVEF, could improve risk stratification.
先前的研究表明，放射性核素右心室（RV）射血分数（RVEF）、三尖瓣环平面收缩期位移（TAPSE）和组织多普勒峰值收缩期三尖瓣环速度（STr）是左心室收缩功能障碍（LVSD）稳定患者心存活的独立预测因素。尚无研究比较这三个 RV 参数的预后价值。本研究旨在比较 RVEF、TAPSE 和 STr 在一组 LVSD 患者中的预后价值。
我们分析了 527 例连续接受广泛预后评估（临床数据、生物学数据、放射性核素血管造影、超声心动图）的患者。三尖瓣环平面收缩期位移和 STr 与 RVEF 弱相关（r = 0.20）。在 1268 天（802-1830）的随访期间，有 121 例心血管死亡。RVEF、STr 和 TAPSE 的最佳截断值分别为 37%、9.7cm/s 和 18.5mm。右心室射血分数是心存活的有力独立预测因素[相对风险（RR）：2.05（1.29-3.26），P=0.002]。峰值收缩期三尖瓣环速度增加了适度的预后信息[RR：1.56（1.02-2.39），P=0.04]。然而，STr 与 RVEF 的组合是心血管死亡的最强预测因子。三尖瓣环平面收缩期位移不是心存活的独立预测因子。
右心室收缩功能仍然是临床结局的有力独立预测因素。即使在完整的超声心动图评估背景下，放射性核素 RVEF 仍然是预测心存活的最有力 RV 收缩参数。然而，除了 RVEF 之外，确定 STr 可以改善风险分层。
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