Ramjee Vimal, Grossestreuer Anne V, Yao Yuan, Perman Sarah M, Leary Marion, Kirkpatrick James N, Forfia Paul R, Kolansky Daniel M, Abella Benjamin S, Gaieski David F
Cardiovascular Medicine Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States.
Center for Resuscitation Science, University of Pennsylvania, United States.
Resuscitation. 2015 Nov;96:186-91. doi: 10.1016/j.resuscitation.2015.08.008. Epub 2015 Aug 28.
Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction.
A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012.
291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous circulation (ROSC) and post-arrest echocardiograms.
Of the 291 patients, 57% were male, with a mean age of 59 ± 16 years. 179 (63%) patients had LV dysfunction, 173 (59%) had RV dysfunction, and 124 (44%) had biventricular dysfunction on the initial post-arrest echocardiogram. Independent of LV function, RV dysfunction was predictive of worse survival (mild or moderate: OR 0.51, CI 0.26-0.99, p<0.05; severe: OR 0.19, CI 0.06-0.65, p=0.008) and neurologic outcome (mild or moderate: OR 0.33, CI 0.17-0.65, p=0.001; severe: OR 0.11, CI 0.02-0.50, p=0.005) compared to patients with normal RV function after cardiac arrest.
Echocardiographic findings of post-arrest RV dysfunction were equally prevalent as LV dysfunction. RV dysfunction was significantly predictive of worse outcomes in post-arrest patients after accounting for LV dysfunction. Post-arrest RV dysfunction may be useful for risk stratification and management in this high-mortality population.
心脏骤停复苏后的临床结局在骤停后的即刻阶段仍难以确定。复苏后不久的超声心动图评估主要集中在左心室（LV）功能上。我们旨在确定心脏骤停患者复苏后右心室（RV）功能障碍是否独立于LV功能障碍，预示着更差的生存率和不良神经学结局。
在一所三级医疗大学医院进行的单中心回顾性队列研究，该医院于2000年至2012年参与了宾夕法尼亚治疗性低温联盟（PATH）注册研究。
宾夕法尼亚大学291例院内外成年心脏骤停患者，这些患者恢复了自主循环（ROSC）并进行了骤停后超声心动图检查。
291例患者中，57%为男性，平均年龄59±16岁。在初次骤停后超声心动图检查中，179例（63%）患者存在LV功能障碍，173例（59%）存在RV功能障碍，124例（44%）存在双心室功能障碍。与心脏骤停后RV功能正常的患者相比，独立于LV功能，RV功能障碍预示着更差的生存率（轻度或中度：OR 0.51，CI 0.26 - 0.99，p<0.05；重度：OR 0.19，CI 0.06 - 0.65，p = 0.008）和神经学结局（轻度或中度：OR 0.33，CI 0.17 - 0.65，p = 0.001；重度：OR 0.11，CI 0.02 - 0.50，p = 0.005）。
骤停后RV功能障碍的超声心动图表现与LV功能障碍同样常见。在考虑LV功能障碍后，RV功能障碍显著预示着骤停后患者更差的结局。骤停后RV功能障碍可能有助于对这一高死亡率人群进行风险分层和管理。
