Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
Int J Cardiol. 2017 Dec 1;248:320-325. doi: 10.1016/j.ijcard.2017.08.047. Epub 2017 Aug 24.
To determine whether right atrial (RA) function has prognostic value in patients with idiopathic pulmonary arterial hypertension (PAH).
Overall, 104 patients (70 female, mean age 58±13years) with idiopathic PAH underwent standard Doppler echocardiography and strain and strain rate (SR) analysis before right heart catheterization. At a mean follow-up of 22±7months, 30 patients (29%) had clinical worsening. On Cox multivariable proportional-hazards regression analysis, RA reservoir function measured as peak longitudinal SR (hazard ratio [HR] 0.5; P<0.0001), RA area (HR 1.2; P<0.01), right ventricular (RV) SR (HR 0.6; P<0.0001), cardiac index (HR 0.79; P<0.01), and mixed venous oxygen saturation (HR 0.82; P<0.01) were found to be independent correlates of cardiac events. A RA SR reservoir cut-off value of <1.2s and a RV SR cut-off value of <1s well identified patients at higher risk of clinical worsening (sensitivity 85.5%; specificity 90.4%; test accuracy 88.8%). In particular, event rates and mean survival time free of clinical worsening were: 6.1% and 23.5±2.2months in patients with normal RA and RV SR; 45% and 20.9±5.5months in patients with impaired RA and normal RV SR; 56.2% and 17.7±6.6months in patients with normal RA and impaired RV SR; and 87.5% and 12.9±7.6months in patients with impairment of both RA and RV SR.
Our data suggest that RA function has prognostic value in idiopathic PAH, where a poorer RA function, as explored by strain and SR analysis, is associated with a worse outcome.
确定右心房（RA）功能在特发性肺动脉高压（PAH）患者中的预后价值。
共有 104 例特发性 PAH 患者（70 例女性，平均年龄 58±13 岁）接受了标准多普勒超声心动图和应变及应变率（SR）分析，然后进行右心导管检查。平均随访 22±7 个月后，30 例（29%）患者出现临床恶化。在 Cox 多变量比例风险回归分析中，RA 储备功能以峰值纵向 SR（危险比[HR]0.5；P<0.0001）、RA 面积（HR 1.2；P<0.01）、右心室（RV）SR（HR 0.6；P<0.0001）、心指数（HR 0.79；P<0.01）和混合静脉血氧饱和度（HR 0.82；P<0.01）来衡量，这些都是心脏事件的独立相关因素。RA SR 储备截断值<1.2s 和 RV SR 截断值<1s 可以很好地识别出临床恶化风险较高的患者（敏感性 85.5%；特异性 90.4%；测试准确性 88.8%）。特别是，正常 RA 和 RV SR 的患者事件发生率和无临床恶化的平均生存时间分别为：6.1%和 23.5±2.2 个月；RA 受损而 RV SR 正常的患者为 45%和 20.9±5.5 个月；RA 正常而 RV SR 受损的患者为 56.2%和 17.7±6.6 个月；而 RA 和 RV SR 均受损的患者为 87.5%和 12.9±7.6 个月。
我们的数据表明，RA 功能在特发性 PAH 中有预后价值，应变和 SR 分析显示 RA 功能较差与预后较差相关。
