Teixeira Rogério, Monteiro Ricardo, Garcia João, Baptista Rui, Ribeiro Miguel, Cardim Nuno, Gonçalves Lino
Departamento de Medicina, Serviço de Cardiologia, Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal,
Int J Cardiovasc Imaging. 2015 Aug;31(6):1125-35. doi: 10.1007/s10554-015-0663-5. Epub 2015 Apr 24.
The aim at this study was to assess the influence of the tricuspid regurgitation volume (TRvol) in right atrium (RA) reservoir phase myocardial mechanics. We included 55 heart failure (HF) patients referred for transthoracic echocardiography during a 2-month period. 18 Had HF with a reduced ejection fraction (HFREF) and 37 HF with a preserved ejection fraction (HFPEF). TR was chronic and functional. TRvol was calculated according to the PISA method. This study of RA used 2D-speckle tracking echocardiography to measure strain (rεR) and strain rate (rSR(R)). The reference frame coincided with the onset of the QRS. RA stiffness was assessed as the ratio: (rE/e')/rε(R). The median age of the sample was 78 (64-84) years, with female gender predominance (63.6%). The median value of rε(R) was 16% (range, 12.7-24.0) and of rSR(R) was 1.57 s(-1) (range, 1.09-2.05). We observed a significant negative correlation between rε(R) (r = -0.68, p < 0.01) and rSR(R) (r = -0.58, p < 0.01) and TRvol. RA mechanics decreased significantly with an increase in the TR grade. We created two multivariate linear regression models for rε(R) and rSR(R), separately for the patients with sinus rhythm or atrial fibrillation. The TRvol was independently associated with rε(R) after adjusting to the RA area, right ventricular longitudinal systolic function and the estimated pulmonary vascular resistance. We demonstrated an increase in RA stiffness with an increase in TR severity, and an association for functional status (NYHA class) and RA compliance. The HFREF group had a significantly lower rε(R) and rSR(R) that the HFPEF patients. According to our study, in HF patients, a chronic volume overload state significantly reduced the RA reservoir phase mechanics.
本研究旨在评估三尖瓣反流容积（TRvol）对右心房（RA）储存期心肌力学的影响。我们纳入了在2个月期间因经胸超声心动图检查而转诊的55例心力衰竭（HF）患者。其中18例为射血分数降低的心力衰竭（HFREF）患者，37例为射血分数保留的心力衰竭（HFPEF）患者。三尖瓣反流为慢性功能性反流。TRvol根据PISA法计算。本研究对RA采用二维斑点追踪超声心动图测量应变（rεR）和应变率（rSR(R)）。参考帧与QRS波起始点一致。RA僵硬度评估为比值：(rE/e')/rε(R)。样本的中位年龄为78（64 - 84）岁，女性占优势（63.6%）。rε(R)的中位值为16%（范围12.7 - 24.0），rSR(R)的中位值为1.57 s(-1)（范围1.09 - 2.05）。我们观察到rε(R)（r = -0.68，p < 0.01）和rSR(R)（r = -0.58，p < 0.01）与TRvol之间存在显著负相关。随着TR分级增加，RA力学显著下降。我们分别为窦性心律或心房颤动患者创建了针对rε(R)和rSR(R)的两个多元线性回归模型。在调整RA面积、右心室纵向收缩功能和估计的肺血管阻力后，TRvol与rε(R)独立相关。我们证明随着TR严重程度增加，RA僵硬度增加，且与功能状态（NYHA分级）和RA顺应性相关。HFREF组的rε(R)和rSR(R)显著低于HFPEF患者。根据我们的研究，在HF患者中，慢性容量超负荷状态显著降低了RA储存期力学。
