三尖瓣环收缩期峰值速度预测急性肺栓塞不良结局的时间短于三尖瓣环平面收缩期位移。
Peak systolic velocity of tricuspid annulus is inferior to tricuspid annular plane systolic excursion for 30 days prediction of adverse outcome in acute pulmonary embolism.
机构信息
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland.
1 st Department of Radiology, Medical University of Warsaw, Chałubińskiego str 5, 02-004 Warsaw, Poland.
出版信息
Cardiol J. 2020;27(5):558-565. doi: 10.5603/CJ.a2018.0145. Epub 2018 Nov 28.
BACKGROUND
Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S'), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients.
METHODS
One hundred and thirty nine consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis.
RESULTS
Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4-80.0; p = 0.02); TAPSE and TV S' showed HR 0.77 (0.67-0.89), p < 0.001, and 0.71 (0.52-0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812-0.932, p = 0.0001, for TV S' was 0.751; 95% CI 0.670-0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83-0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52-0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE ≥ 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S' was only of borderline statistical significance.
CONCLUSIONS
It seems that TV S' is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism.
背景
三尖瓣环平面收缩期位移（TAPSE）是右心室（RV）收缩功能的既定指标，也是高血压患者肺栓塞（PE）的重要预测因子。最近，多普勒组织成像衍生的三尖瓣环收缩期速度（TV S'），作为 RV 功能的现代参数，被报道在广泛的心脏病诊断和预后中有一定价值。因此，本研究分析了 TAPSE 和 TV S'在高血压性 PE 患者中的预后价值。
方法
本研究纳入了 139 例连续的 PE 患者（76 名女性，年龄 56.4 ± 19.5 岁）。所有患者均接受初始抗凝治疗。入院时行经胸超声心动图检查。研究终点（SE）定义为与 PE 相关的 30 天死亡率和/或需要补救溶栓。
结果
符合 SE 标准的 7 例（5%）患者在超声心动图上表现出更严重的 RV 功能障碍。单变量 Cox 回归分析显示，RV/LV 比预测 SE 的风险比（HR）为 10.6（1.4-80.0；p = 0.02）；TAPSE 和 TV S'的 HR 分别为 0.77（0.67-0.89），p < 0.001 和 0.71（0.52-0.97），p = 0.03。TAPSE 预测 SE 的曲线下面积为 0.881；95%CI 0.812-0.932，p = 0.0001，TV S'为 0.751；95%CI 0.670-0.820，p = 0.001。多变量分析显示，最佳预测模型包括 TAPSE 和收缩压（SBP，HR 为 0.89，95%CI 0.83-0.95，p < 0.001，TAPSE HR 为 0.67，95%CI 0.52-0.87，p < 0.03）。Kaplan-Meier 分析显示，初始 TAPSE≥18mm 的 PE 患者预后明显优于 TAPSE<18mm 的患者（p<0.01），而 S'分析仅具有边缘统计学意义。
结论
在急性肺栓塞的 30 天不良预后预测中，TV S'似乎不如 TAPSE。
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