Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan.
JAMA Cardiol. 2018 Oct 1;3(10):939-948. doi: 10.1001/jamacardio.2018.2454.
Limited data exist on the prevalence and prognostic importance of right ventricular (RV) dysfunction for heart failure (HF) in the general population.
To assess the prevalence of RV dysfunction and its association with HF and mortality in a community-based elderly cohort.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional and time-to-event analysis of participants in the Atherosclerosis Risks in the Community (ARIC), a multicenter, population-based cohort study at the fifth study visit from 2011 to 2013, with a median follow-up of 4.1 years. This study included 1004 elderly participants in the ARIC study attending the fifth study visit who underwent both 3-dimensional and 2-dimensional RV echocardiography. Three-dimensional echocardiography data were analyzed between September 15, 2015, and July 24, 2016.
Right ventricular ejection fraction (RVEF), RV-pulmonary artery (PA) coupling defined by the RVEF/PA systolic pressure (PASP) ratio, and RV longitudinal strain by 3-dimensional echocardiography.
For cross-sectional analysis, the prevalence of RV dysfunction across ACCF/AHA HF stages (0; A, at elevated risk for HF but without structural heart disease or clinical HF; B, structural heart disease but without clinical HF; and C, prevalent HF). For time-to-event analysis, a composite of incident HF hospitalization or all-cause death among participants free of HF at visit 5.
Of the 1004 participants, mean (SD) age was 76 (5) years, 385 were men (38%), and 121 were black (12%). Mean (SD) RVEF was 53% (8%). Right ventricular EF, RVEF/PASP, and RV longitudinal strain were each progressively lower across advancing HF stages. Using reference limits from stage 0 participants, RVEF was abnormal in 103 asymptomatic persons with stage A HF (15%) and 27 with stage B HF (24%). Among participants free of HF at baseline, lower RVEF and worse RV-PA coupling (ie, lower RVEF/PASP ratio) both were associated with incident HF or death independent of LVEF and N-terminal pro b-type natriuretic peptide (hazard ratio, 1.20; 95% CI, 1.02-1.42 per 5% decrease in RVEF; P = .03; hazard ratio, 1.65, 95% CI, 1.15-2.37 per 0.5 unit decrease in RVEF/PASP ratio; P = .007).
Right ventricular function and RV-PA coupling declined progressively across American College of Cardiology Foundation/American Heart Association HF stages. Among persons free of HF, lower RVEF was associated with incident HF or death independent of LVEF or N-terminal pro b-type natriuretic peptide.
关于普通人群中心力衰竭（HF）中右心室（RV）功能障碍的患病率和预后重要性，现有数据有限。
评估社区老年人队列中 RV 功能障碍的患病率及其与 HF 和死亡率的关系。
设计、地点和参与者：这是一项横断面和时间事件分析，参与者来自多中心、基于人群的 Atherosclerosis Risks in the Community（ARIC）研究，在 2011 年至 2013 年的第五次研究访问中进行，中位随访时间为 4.1 年。本研究纳入了 1004 名参加 ARIC 研究的老年人，他们在第五次研究访问时接受了三维和二维 RV 超声心动图检查。三维超声心动图数据于 2015 年 9 月 15 日至 2016 年 7 月 24 日进行分析。
右心室射血分数（RVEF）、由 RVEF/PA 收缩压（PASP）比值定义的 RV-PA 偶联以及通过三维超声心动图测量的 RV 纵向应变。
对于横断面分析，根据美国心脏病学会基金会/美国心脏协会 HF 分期（0 期；A 期，HF 风险升高但无结构性心脏病或临床 HF；B 期，结构性心脏病但无临床 HF；C 期，HF 流行）评估 RV 功能障碍的患病率。对于时间事件分析，评估无 HF 的参与者在第 5 次就诊时发生 HF 住院或全因死亡的复合终点。
在 1004 名参与者中，平均（标准差）年龄为 76（5）岁，385 名男性（38%），121 名黑人（12%）。平均 RVEF 为 53%（8%）。随着 HF 分期的进展，RVEF、RVEF/PASP 和 RV 纵向应变逐渐降低。使用 0 期参与者的参考范围，103 名无症状 A 期 HF 患者（15%）和 27 名 B 期 HF 患者（24%）的 RVEF 异常。在基线时无 HF 的参与者中，较低的 RVEF 和较差的 RV-PA 偶联（即，较低的 RVEF/PASP 比值）与 HF 或死亡的发生独立相关，独立于 LVEF 和 N-末端 pro-B 型利钠肽（NT-proBNP）（每降低 5%，风险比为 1.20；95%CI，1.02-1.42；P=0.03；每降低 0.5 单位 RVEF/PASP 比值，风险比为 1.65；95%CI，1.15-2.37；P=0.007）。
在 ACCF/AHA HF 分期中，RV 功能和 RV-PA 偶联逐渐下降。在无 HF 的人群中，较低的 RVEF 与 HF 或死亡的发生独立于 LVEF 或 NT-proBNP 相关。
