Sano Hiroyuki, Tanaka Hidekazu, Motoji Yoshiki, Fukuda Yuko, Sawa Takuma, Mochizuki Yasuhide, Ryo Keiko, Matsumoto Kensuke, Emoto Noriaki, Hirata Ken-Ichi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Can J Cardiol. 2015 Apr;31(4):529-36. doi: 10.1016/j.cjca.2015.01.027. Epub 2015 Jan 28.
Right ventricular (RV) dysfunction in pulmonary hypertension (PH) is linked to adverse outcomes, but this response is considered heterogeneous because it can be associated with multiple factors.
RV function of 51 PH patients was calculated by averaging peak speckle-tracking longitudinal strain from RV free-wall (RV-free), and the cutoff for RV dysfunction was predefined as RV-free ≤ 19%. Right-sided heart remodelling was assessed in terms of RV end-systolic area (RVESA) and right atrial (RA) area (RA-area). Midterm reverse remodelling was defined as a relative decrease in RVESA (ΔRVESA) and RA-area (ΔRA-area) of at least 15% at 5.7 ± 4.0 months after introduction of pulmonary artery hypertension-specific drugs. Long-term outcome was tracked for 3.0 ± 2.0 years.
Patients with midterm RV and RA reverse remodelling showed more favourable long-term outcomes than those without (P = 0.01, P = 0.047, respectively). Sequential Cox models showed that a model based on hemodynamic parameters (χ(2) = 0.3) was improved by the addition of RV-free (χ(2) = 6.4; P = 0.01), and further improved by addition of ΔRVESA and ΔRA-area (χ(2) = 28.2; P < 0.001). Furthermore, preservation of baseline RV function and midterm reverse remodelling in right-sided heart was associated with an optimal outcome: a survival rate of 100%. In contrast, absence of midterm reverse remodelling in the right-sided heart of patients with impaired baseline RV function was associated with significantly worse outcome with a survival rate of 33% (P = 0.01).
RV function and echocardiographic right-heart reverse remodelling with therapy improves the prediction of long-term outcomes for PH patients over standard hemodynamic indices.
肺动脉高压（PH）患者的右心室（RV）功能障碍与不良预后相关，但这种反应被认为具有异质性，因为它可能与多种因素有关。
通过平均右心室游离壁（RV-free）的峰值斑点追踪纵向应变来计算51例PH患者的RV功能，RV功能障碍的临界值预先定义为RV-free≤19%。根据右心室收缩末期面积（RVESA）和右心房（RA）面积（RA-area）评估右心重塑。中期逆向重塑定义为在开始使用肺动脉高压特异性药物后5.7±4.0个月时，RVESA（ΔRVESA）和RA面积（ΔRA-area）相对减少至少15%。对长期预后进行了3.0±2.0年的跟踪。
中期RV和RA逆向重塑的患者比未发生逆向重塑的患者显示出更有利的长期预后（分别为P = 0.01，P = 0.047）。序贯Cox模型显示，基于血流动力学参数的模型（χ(2)=0.3）在加入RV-free后得到改善（χ(2)=6.4；P = 0.01），在加入ΔRVESA和ΔRA-area后进一步改善（χ(2)=28.2；P < 0.001）。此外，基线RV功能的保留和右心的中期逆向重塑与最佳预后相关：生存率为100%。相比之下，基线RV功能受损的患者右心无中期逆向重塑与明显更差的预后相关，生存率为33%（P = 0.01）。
与标准血流动力学指标相比，RV功能和治疗后超声心动图显示的右心逆向重塑可改善对PH患者长期预后的预测。
