Cardiac Division, Department of Echocardiography, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (E.S.).
Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., M.T., B.K.L., B.M.).
Circ Cardiovasc Imaging. 2021 Oct;14(10):e012774. doi: 10.1161/CIRCIMAGING.121.012774. Epub 2021 Sep 30.
The functional adaptation of the right ventricle (RV) to the different degrees of left ventricular (LV) dysfunction remains to be clarified. We sought to (1) assess the changes in RV contraction pattern associated with the reduction of LV ejection fraction (EF) and (2) analyze whether the assessment of RV longitudinal, radial, and anteroposterior motion components of total RVEF adds prognostic value.
Consecutive patients with left-sided heart disease who underwent clinically indicated transthoracic echocardiography were enrolled in a single-center prospective observational study. Adverse outcome was defined as heart failure hospitalization or cardiac death. Cross-sectional analysis using the baseline 3-dimensional echocardiography studies was performed to quantify the relative contribution of the longitudinal, radial, and anteroposterior motion components to total RVEF.
We studied 292 patients and followed them for 6.7±2.2 years. In patients with mildly and moderately reduced LVEF, the longitudinal and the anteroposterior components of RVEF decreased significantly, while the radial component increased resulting in preserved total RVEF (RVEF: 50% [46%-54%] versus 47% [44%-52%] versus 46% [42%-49%] in patients with no, mild, or moderate LV dysfunction, respectively; data presented as median and interquartile range). In patients with severe LV systolic dysfunction (n=34), a reduction in all 3 RV motion components led to a significant drop in RVEF (30% [25%-39%], <0.001). In patients with normal RVEF (>45%), the anteroposterior component of total RVEF was a significant and independent predictor of outcome (hazard ratio, 0.960 [CI, 0.925-0.997], <0.001).
In patients with left-sided heart disease, there is a significant remodeling of the RV associated with preservation of the RVEF in patients with mild or moderate LV dysfunction. In patients with normal RVEF, the measurement of the anteroposterior component of RV motion provided independent prognostic value.
右心室（RV）对左心室（LV）不同程度功能障碍的功能适应性仍需阐明。我们试图（1）评估与 LV 射血分数（EF）降低相关的 RV 收缩模式的变化，以及（2）分析 RV 纵向、径向和前后运动成分的总和是否对 RVEF 的评估具有预后价值。
连续入选因左心疾病接受临床指征性经胸超声心动图检查的患者，进行单中心前瞻性观察性研究。不良结局定义为心力衰竭住院或心脏死亡。使用基线 3 维超声心动图研究进行横截面分析，以量化 RV 射血分数（RVEF）的纵向、径向和前后运动成分的相对贡献。
共纳入 292 例患者，平均随访 6.7±2.2 年。在轻度和中度 LV 射血分数降低的患者中，RVEF 的纵向和前后运动成分显著降低，而径向运动成分增加，导致总 RVEF 保持不变（RVEF：50%[46%-54%]与 47%[44%-52%]与 46%[42%-49%]，分别为无、轻度或中度 LV 功能障碍的患者；数据以中位数和四分位间距表示）。在严重 LV 收缩功能障碍的患者（n=34）中，所有 3 个 RV 运动成分的减少导致 RVEF 显著下降（30%[25%-39%]，<0.001）。在 RVEF 正常（>45%）的患者中，RV 运动的前后运动成分是结局的显著独立预测因素（风险比，0.960[CI，0.925-0.997]，<0.001）。
在左心疾病患者中，存在 RV 的显著重构，与轻度或中度 LV 功能障碍患者的 RVEF 保持一致。在 RVEF 正常的患者中，RV 运动的前后运动成分的测量提供了独立的预后价值。
