Cameli M, Bernazzali S, Lisi M, Tsioulpas C, Croccia M G, Lisi G, Maccherini M, Mondillo S
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
Transplant Proc. 2012 Sep;44(7):2013-5. doi: 10.1016/j.transproceed.2012.06.018.
Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices in patients with refractory heart failure. RV deformation analysis by speckle tracking echocardiography (STE) has recently allowed the analysis of RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed to explore the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) among patients referred for cardiac transplantation.
Right heart catheterization and transthoracic echo-Doppler were simultaneously performed in 47 patients referred for cardiac transplant assessment due to refractory heart failure (ejection fraction 25.1 ± 4.5%). Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging RV free-wall segments (free-wall RVLS). We also calculated. Tricuspid S' and tricuspid annular plane systolic excursion (TAPSE).
No significant correlation was observed for TAPSE on tricuspid S' with RV stroke volume (r = 0.14 and r = 0.06, respectively). A close negative correlation between free-wall RVLS and RVSWI was found (r = -0.82; P < .0001). Furthermore, free-wall RVLS showed the highest diagnostic accuracy (area under the curve of 0.90) with good sensitivity and specificity of 95% and 91%, respectively, to predict depressed RVSWI using a cutoff value less than -11.8%.
Among patients referred for heart transplantation, TAPSE and tricuspid S' did not correlate with invasively obtained RVSWI. RV longitudinal deformation analysis by STE correlated with RVSWI, providing a better estimate of RV systolic performance.
右心室（RV）收缩功能在决定难治性心力衰竭患者的临床结局及使用左心室辅助装置的成功率方面起着关键作用。最近，斑点追踪超声心动图（STE）进行的右心室变形分析已能够对右心室纵向功能进行分析。本研究以心导管检查作为参考标准，旨在探讨因心脏移植而转诊的患者中，STE测定的右心室纵向功能与右心室每搏功指数（RVSWI）之间的相关性。
对47例因难治性心力衰竭（射血分数25.1±4.5%）而接受心脏移植评估的患者同时进行右心导管检查和经胸超声多普勒检查。采用热稀释法测定右心室每搏量和有创肺动脉压以获取RVSWI。通过STE评估右心室纵向应变（RVLS），取右心室游离壁各节段平均值（游离壁RVLS）。我们还计算了三尖瓣S'和三尖瓣环平面收缩期位移（TAPSE）。
TAPSE和三尖瓣S'与右心室每搏量均无显著相关性（r分别为0.14和0.06）。发现游离壁RVLS与RVSWI之间存在密切的负相关（r = -0.82；P <.0001）。此外，游离壁RVLS显示出最高的诊断准确性（曲线下面积为0.90），预测RVSWI降低的敏感性和特异性分别为95%和91%，截断值小于-11.8%。
在因心脏移植而转诊的患者中，TAPSE和三尖瓣S'与有创获得的RVSWI不相关。通过STE进行的右心室纵向变形分析与RVSWI相关，能更好地评估右心室收缩功能。
