Department of Cardiology, Leiden University Medical Center, The Netherlands (E.A.P., P.v.d.B., M.D., R.A., E.M.V., N.A.M., V.D., J.J.B.).
Department of Cardiology, Antwerp Cardiovascular Center, ZNA Middelheim, Belgium (E.A.P.).
Circ Cardiovasc Imaging. 2019 Mar;12(3):e008666. doi: 10.1161/CIRCIMAGING.118.008666.
Background In patients with significant functional tricuspid regurgitation, timely detection of right ventricular (RV) dysfunction with conventional 2-dimensional echocardiography is challenging, whereas speckle-tracking echocardiography RV free wall longitudinal strain has been proposed as better prognosticator. We evaluated the prevalence and prognostic value of impaired RV free wall longitudinal strain in patients with significant functional tricuspid regurgitation, in comparison with tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). Methods Eight hundred ninety-six patients (51.3% men, 71 years [62-78 years]) with significant functional tricuspid regurgitation were divided according to the presence of RV dysfunction (defined as TAPSE <17 mm, FAC <35%, and RV free wall longitudinal strain >-23%) and were followed for the occurrence of all-cause mortality. Results RV free wall longitudinal strain identified the highest percentage of RV dysfunction (84.9%), in comparison to FAC (48.5%) and TAPSE (71.7%). During a median follow-up of 2.8 years (1.3-5.4 years), 443 (49.4%) patients died. Compared with survivors, nonsurvivors showed worse RV systolic dysfunction (FAC=36.5±12.7% versus 33.9±11.8%, P=0.001; TAPSE=15.4±5.0 versus 14.0±4.5 mm, P<0.001; RV free wall longitudinal strain=-15.9±7.5% versus -12.9±6.8%, P<0.001). Cumulative event-free survival was significantly worse in patients with decreased FAC, decreased TAPSE, and impaired RV free wall longitudinal strain. On multivariate analysis, RV free wall longitudinal strain was independently associated with all-cause mortality and incremental to FAC and TAPSE. Conclusions In significant tricuspid regurgitation, impaired RV free wall longitudinal strain identifies higher rates of RV dysfunction and is associated with worse outcome beyond conventional echocardiographic parameters of RV systolic function.
在存在明显功能性三尖瓣反流的患者中，常规二维超声心动图检测右心室（RV）功能障碍具有挑战性，而斑点追踪超声心动图 RV 游离壁纵向应变已被提出作为更好的预后预测因子。我们评估了在存在明显功能性三尖瓣反流的患者中，RV 游离壁纵向应变受损的患病率和预后价值，并与三尖瓣环平面收缩期位移（TAPSE）和分数面积变化（FAC）进行了比较。
896 例（51.3%为男性，71 岁[62-78 岁]）存在明显功能性三尖瓣反流的患者根据 RV 功能障碍的存在情况（定义为 TAPSE<17mm、FAC<35%和 RV 游离壁纵向应变>-23%）进行分组，并对所有原因死亡率的发生进行随访。
与 FAC（48.5%）和 TAPSE（71.7%）相比，RV 游离壁纵向应变可识别出最高比例的 RV 功能障碍（84.9%）。在中位随访 2.8 年（1.3-5.4 年）期间，443 例（49.4%）患者死亡。与幸存者相比，非幸存者的 RV 收缩功能更差（FAC=36.5±12.7%与 33.9±11.8%，P=0.001；TAPSE=15.4±5.0 与 14.0±4.5mm，P<0.001；RV 游离壁纵向应变=-15.9±7.5%与-12.9±6.8%，P<0.001）。FAC 降低、TAPSE 降低和 RV 游离壁纵向应变受损的患者累积无事件生存率明显更差。多变量分析显示，RV 游离壁纵向应变与全因死亡率独立相关，并与 FAC 和 TAPSE 相比具有增量价值。
在明显的三尖瓣反流中，RV 游离壁纵向应变受损可识别出更高比例的 RV 功能障碍，并与常规 RV 收缩功能超声心动图参数以外的预后更差相关。
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