临床无明显右心功能障碍与冠状动脉疾病中肌丝力量发育减少有关。
Clinically inapparent right heart dysfunction is associated with reduced myofilament force development in coronary artery disease.
机构信息
Department of Thoracic and Cardiovascular Surgery, Zentrum Operative Medizin, University of Wuerzburg, Oberduerrbacherstr. 6, 97080, Wuerzburg, Germany.
Comprehensive Heart Failure Centre (CHFC) Würzburg, University of Wuerzburg, Wuerzburg, Germany.
出版信息
BMC Cardiovasc Disord. 2021 Mar 5;21(1):125. doi: 10.1186/s12872-021-01926-6.
BACKGROUND
Right ventricular dysfunction after CABG is associated with poor peri- and postoperative outcomes. We aimed to identify clinical and experimental predictors for preoperative inapparent right ventricular dysfunction and therefore hypothesized that reduced myofilament force development as well as altered levels of biomarkers might predict inapparent right ventricular dysfunction.
METHODS
From 08/2016 to 02/2018, 218 patients scheduled for CABG were divided into two groups (TAPSE ≥ 20 mm, n = 178; TAPSE < 20 mm, n = 40). Baseline serum samples for biomarkers (Galectin, TGFß1, N Acyl-SDMA, Arginine, ADMA and Pentraxin-3), clinical laboratory and transthoracic echocardiographic parameters were evaluated. To examine the myocardial apparatus of the right ventricle intraoperative right auricular tissue was harvested for stepwise skinned fiber force measurements.
RESULTS
Patients with TAPSE < 20 mm had a higher incidence of DM (55 vs. 34%, p = 0.018), preoperative AFib (43 vs. 16%, p < 0.001), reduced GFR (67 ± 18 vs. 77 ± 24 ml/min/1.73 m, p = 0.013), larger LA area (22 ± 6 vs. 20 ± 5 cm, p = 0.005) and reduced LVEF (50 vs. 55%, p = 0.008). Furthermore, higher serum ADMA (0.70 ± 0.13 vs. 0.65 ± 0.15 µmol/l, p = 0.046) and higher serum Pentraxin-3 levels (3371 ± 1068 vs. 2681 ± 1353 pg/dl, p = 0.004) were observed in these patients. Skinned fiber force measurements showed significant lower values at almost every step of calcium concentration (pCa 4.52 to pCa 5.5, p < 0.01 and pCa 5.75-6.0, p < 0.05). Multivariable analysis revealed DM (OR 2.53, CI 1.12-5.73, Euro Score II (OR 1.34, CI 1.02-1.78), preoperative AF (OR 4.86, CI 2.06-11.47), GFR (OR 7.72, CI 1.87-31.96), albumin (OR 1.56, CI 0.52-2.60), Pentraxin-3 (OR 19.68, CI 14.13-25.24), depressed LVEF (OR 8.61, CI 6.37-10.86), lower force values: (pCa 5.4; OR 2.34, CI 0.40-4.29 and pCa 5.2; OR 2.00, CI 0.39-3.60) as predictors for clinical inapparent right heart dysfunction.
CONCLUSIONS
These preliminary data showed that inapparent right heart dysfunction in CAD is already associated with reduced force development of the contractile apparatus.
背景
CABG 后的右心室功能障碍与围手术期不良预后相关。我们旨在确定术前无症状右心室功能障碍的临床和实验预测因子，并因此假设收缩机制力发展减弱以及生物标志物水平改变可能预测无症状右心室功能障碍。
方法
从 2016 年 8 月到 2018 年 2 月，218 名计划接受 CABG 的患者被分为两组（TAPSE≥20mm，n=178；TAPSE<20mm，n=40）。评估基线血清标志物（半乳糖凝集素、TGFβ1、N-乙酰-SDMA、精氨酸、ADMA 和 Pentraxin-3）、临床实验室和经胸超声心动图参数。为了检查右心室的心肌装置，术中采集右心耳组织进行逐步去神经纤维力测量。
结果
TAPSE<20mm 的患者糖尿病（DM）发生率较高（55% vs. 34%，p=0.018）、术前心房颤动（AFib）（43% vs. 16%，p<0.001）、肾小球滤过率（GFR）降低（67±18 vs. 77±24ml/min/1.73m，p=0.013）、左心房面积较大（22±6 vs. 20±5cm，p=0.005）和左心室射血分数（LVEF）降低（50% vs. 55%，p=0.008）。此外，这些患者的血清 ADMA（0.70±0.13 vs. 0.65±0.15µmol/l，p=0.046）和血清 Pentraxin-3 水平（3371±1068 vs. 2681±1353pg/dl，p=0.004）更高。在几乎每个钙离子浓度阶段（pCa 4.52 至 pCa 5.5，p<0.01 和 pCa 5.75-6.0，p<0.05），去神经纤维力测量均显示出显著较低的值。多变量分析显示 DM（OR 2.53，CI 1.12-5.73，Euro Score II（OR 1.34，CI 1.02-1.78），术前 AF（OR 4.86，CI 2.06-11.47），GFR（OR 7.72，CI 1.87-31.96），白蛋白（OR 1.56，CI 0.52-2.60），Pentraxin-3（OR 19.68，CI 14.13-25.24），LVEF 降低（OR 8.61，CI 6.37-10.86），力值降低（pCa 5.4；OR 2.34，CI 0.40-4.29 和 pCa 5.2；OR 2.00，CI 0.39-3.60）是 CAD 无症状右心功能障碍的预测因子。
结论
这些初步数据表明，CAD 中无症状右心功能障碍已经与收缩机制力发展减弱相关。
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