Liu Bing-Yang, Wu Wei-Chun, Zeng Qi-Xian, Liu Zhi-Hong, Niu Li-Li, Tian Yue, Cheng Xiao-Ling, Luo Qin, Zhao Zhi-Hui, Huang Li, Wang Hao, He Jian-Guo, Xiong Chang-Ming
Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China.
Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
Int J Cardiovasc Imaging. 2019 Aug;35(8):1499-1508. doi: 10.1007/s10554-019-01605-w. Epub 2019 Apr 29.
Resting two-dimensional speckle tracking echocardiography (2D-STE) identified right ventricular (RV) systolic function were reported to predict exercise capacity in pulmonary hypertension (PH) patients, but little attention had been payed to 2D-STE detected RV diastolic function. Therefore, we aim to elucidate and compare the relations between 2D-STE identified RV diastolic/systolic functions and peak oxygen consumption (PVO) determined by cardiopulmonary exercise testing (CPET) in pre-capillary PH. 2D-STE was performed in 66 pre-capillary PH patients and 28 healthy controls. Linear correlation and multivariate regression analyses were performed to evaluate and compare the relations between RV 2D-STE parameters and PVO. Receiver operating characteristic curves were used to compare the predictive value of 2D-STE parameters in predicting the cut-off-PVO < 11 ml/min/kg. There were significant differences of all the 2D-STE parameters between PH patients and healthy controls. In patients, RV-peak global longitudinal strain (GLS, r = - 0.498, P < 0.001), RV- peak systolic strain rate (GSRs, r = - 0.537, P < 0.001) and RV- peak early diastolic strain rate (GSRe, r = 0.527, P < 0.001) significantly correlated with PVO, but no significant correlation was observed between RV- peak late diastolic strain rate (GSRa, r = 0.208, P = 0.093) and PVO. The first multivariate regression analysis of clinical data without echocardiographic parameters identified WHO functional class, NT-proBNP and BMI as independent predictors of PVO (Model-1, adjusted r = 0.421, P < 0.001); Then we added conventional echocardiographic parameters and 2D-STE parameters to the clinical data, identified S,(Model-2,adjusted r = 0.502, P < 0.001), RV-GLS (Model-3, adjusted r = 0.491, P < 0.001), RV-GSRe (Model-4, adjusted r = 0.500, P < 0.001) and RV-GSRs (Model-5, adjusted r = 0.519, P < 0.001) as independent predictors of PVO, respectively. The predictive power was increased, and Model-5 including RV-GSRs showed the highest predictive capability. ROC curves found RV-GSRs expressed the strongest predictive value (AUC = 0.88, P < 0.001), and RV-GSRs > - 0.65/s had a 88.2% sensibility and 82.2% specificity to predict PVO < 11 ml/min/kg. 2D-STE assessed RV function improves the prediction of exercise capacity represented by PVO in pre-capillary PH.
静息二维斑点追踪超声心动图（2D-STE）所识别的右心室（RV）收缩功能据报道可预测肺动脉高压（PH）患者的运动能力，但2D-STE检测的RV舒张功能却很少受到关注。因此，我们旨在阐明并比较2D-STE识别的RV舒张/收缩功能与毛细血管前PH患者心肺运动试验（CPET）测定的峰值耗氧量（PVO）之间的关系。对66例毛细血管前PH患者和28例健康对照者进行了2D-STE检查。进行线性相关和多因素回归分析以评估和比较RV 2D-STE参数与PVO之间的关系。采用受试者工作特征曲线比较2D-STE参数预测PVO<11 ml/min/kg临界值的预测价值。PH患者与健康对照者之间所有2D-STE参数均存在显著差异。在患者中，RV-峰值整体纵向应变（GLS，r = -0.498，P<0.001）、RV-峰值收缩应变率（GSRs，r = -0.537，P<0.001）和RV-峰值舒张早期应变率（GSRe，r = 0.527，P<0.001）与PVO显著相关，但RV-峰值舒张晚期应变率（GSRa，r = 0.208，P = 0.093）与PVO之间未观察到显著相关性。首次对不包含超声心动图参数的临床数据进行多因素回归分析，确定世界卫生组织功能分级、NT-proBNP和BMI为PVO的独立预测因素（模型1，调整后r = 0.421，P<0.001）；然后我们将传统超声心动图参数和2D-STE参数添加到临床数据中，分别确定S（模型2，调整后r = 0.502，P<0.001）、RV-GLS（模型3，调整后r = 0.491，P<0.001）、RV-GSRe（模型4，调整后r = 0.500，P<0.001）和RV-GSRs（模型5，调整后r = 0.519，P<0.001）为PVO的独立预测因素。预测能力增强，包含RV-GSRs的模型5显示出最高的预测能力。ROC曲线发现RV-GSRs表现出最强的预测价值（AUC = 0.88，P<0.001），RV-GSRs>-0.65/s预测PVO<11 ml/min/kg的敏感度为88.2%，特异度为82.2%。2D-STE评估的RV功能改善了毛细血管前PH患者以PVO表示的运动能力的预测。
