Department of Cardiovascular Disease, University of Siena, Siena, Italy; Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.
Department of Cardiovascular Disease, University of Siena, Siena, Italy.
JACC Cardiovasc Imaging. 2015 May;8(5):514-522. doi: 10.1016/j.jcmg.2014.12.026. Epub 2015 Apr 15.
This study was performed to determine the accuracy of right ventricular (RV) longitudinal strain (LS) in predicting myocardial fibrosis in patients with severe heart failure (HF) undergoing heart transplantation.
RVLS plays a key role in the evaluation of its systolic performance and clinical outcome in patients with refractory HF.
We studied 27 patients with severe systolic HF (ejection fraction ≤25% and New York Heart Association functional class III to IV, despite full medical therapy and cardiac resynchronization therapy) using echocardiography before heart transplantation. RV free wall LS, right atrial LS, sphericity index (SI), and tricuspid annular plane systolic excursion (TAPSE) were all measured. Upon removal of the heart, from the myocardial histologic analysis, the ratio of the fibrotic to the total sample area determined the extent of fibrosis (%).
RV myocardial fibrosis correlated with RV free wall LS (r = 0.80; p < 0.0001), SI (r = 0.42; p = 0.01) and VO2 max (r = -0.41; p = 0.03), with a poor correlation with TAPSE (r = -0.34; p = 0.05) and right atrial LS (r = -0.37; p = 0.03). Stepwise multivariate analysis showed that RV free wall LS (β = 0.701, p < 0.0001) was independently associated with RV fibrosis (overall model R(2) = 0.64, p < 0.0001). RV free wall LS was the main determinant of myocardial fibrosis. In the subgroup of patients with severe RV fibrosis, RV free wall LS had the highest diagnostic accuracy for detecting severe myocardial fibrosis (area under the curve = 0.87; 95% confidence interval: 0.80 to 0.94).
In late-stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate functional measure that correlates with the extent of RV myocardial fibrosis and functional capacity.
本研究旨在确定右心室（RV）纵向应变（LS）在预测接受心脏移植的重度心力衰竭（HF）患者心肌纤维化中的准确性。
RVLS 在评估难治性 HF 患者的收缩功能和临床结局方面发挥着关键作用。
我们对 27 例接受心脏移植前接受超声心动图检查的严重收缩性 HF 患者（射血分数≤25%，纽约心脏协会功能分级 III 至 IV 级，尽管接受了充分的药物治疗和心脏再同步治疗）进行了研究。测量 RV 游离壁 LS、右心房 LS、球形指数（SI）和三尖瓣环平面收缩期位移（TAPSE）。在心脏取出后，从心肌组织学分析中，纤维化与总样本面积的比值确定纤维化程度（%）。
RV 心肌纤维化与 RV 游离壁 LS（r=0.80；p<0.0001）、SI（r=0.42；p=0.01）和 VO2 max（r=-0.41；p=0.03）相关，与 TAPSE（r=-0.34；p=0.05）和右心房 LS（r=-0.37；p=0.03）的相关性较差。逐步多元分析显示，RV 游离壁 LS（β=0.701，p<0.0001）与 RV 纤维化独立相关（整体模型 R2=0.64，p<0.0001）。RV 游离壁 LS 是心肌纤维化的主要决定因素。在严重 RV 纤维化的患者亚组中，RV 游离壁 LS 对检测严重心肌纤维化具有最高的诊断准确性（曲线下面积=0.87；95%置信区间：0.80 至 0.94）。
在晚期 HF 患者中，由于严重的心肌纤维化，右心室扩大，收缩功能降低。RV 游离壁心肌变形是最准确的功能测量指标，与 RV 心肌纤维化程度和功能能力相关。
