Université Côte d'Azur, Inria Asclepios Research Project, 2004 route des Lucioles - BP 93, 06902 Sophia Antipolis, France.
Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France.
Eur Heart J Cardiovasc Imaging. 2018 Apr 1;19(4):450-458. doi: 10.1093/ehjci/jex163.
Survival in pulmonary hypertension (PH) relates to right ventricular (RV) function. However, the RV unique anatomy and structure limit 2D analysis and its regional 3D function has not been studied yet. The aim of this study was to assess the implications of global and regional 3D RV deformation on clinical condition and survival in adults with PH and healthy controls.
We collected a prospective longitudinal cohort of 104 consecutive PH patients and 34 healthy controls between September 2014 and December 2015. Acquired 3D transthoracic RV echocardiographic sequences were analysed by semi-automatic software (TomTec 4D RV-Function 2.0). Output meshes were post-processed to extract regional motion and deformation. Global and regional statistics provided deformation patterns for each subgroup of subjects. RV lateral and inferior regions showed the highest deformation. In PH patients, RV global and regional motion and deformation [both circumferential, longitudinal, and area strain (AS)] were affected in all segments (P < 0.001 against healthy controls). Deformation patterns gradually worsened with the clinical condition. Over 6.7 [5.8-7.2] months follow-up, 16 (15.4%) patients died from cardio-pulmonary causes. Right atrial pressure, global RV AS, tricuspid annular plane systolic excursion, 3D RV ejection fraction, and end-diastolic volume were independent predictors of survival. Global RV AS > -18% was the most powerful RV function parameter, identifying patients with a 48%-increased risk of death (AUC 0.83 [0.74-0.90], P < 0.001).
Right ventricular strain patterns gradually worsen in PH patients and provide independent prognostic information in this population.
肺动脉高压（PH）患者的生存率与右心室（RV）功能有关。然而，RV 的独特解剖结构限制了二维分析，其区域性三维功能尚未得到研究。本研究旨在评估整体和区域性 3D RV 变形对成人 PH 患者和健康对照者临床状况和生存率的影响。
我们收集了 2014 年 9 月至 2015 年 12 月期间连续的 104 例 PH 患者和 34 例健康对照者的前瞻性纵向队列。使用半自动化软件（TomTec 4D RV-Function 2.0）分析获得的 3D 经胸 RV 超声心动图序列。输出网格经过后处理，以提取区域性运动和变形。RV 外侧和下侧区域显示出最高的变形。在 PH 患者中，RV 整体和区域性运动和变形（包括环向、纵向和面积应变（AS））在所有节段均受到影响（与健康对照组相比，P < 0.001）。变形模式随着临床状况的恶化而逐渐恶化。在 6.7[5.8-7.2]个月的随访中，16（15.4%）例患者因心肺原因死亡。右心房压、整体 RV AS、三尖瓣环平面收缩期位移、3D RV 射血分数和舒张末期容积是生存的独立预测因子。RV AS > -18%是最有力的 RV 功能参数，可识别出 48%死亡风险增加的患者（AUC 0.83 [0.74-0.90]，P < 0.001）。
PH 患者的 RV 应变模式逐渐恶化，为该人群提供了独立的预后信息。
