Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA.
JACC Cardiovasc Imaging. 2022 Apr;15(4):566-574. doi: 10.1016/j.jcmg.2021.09.016. Epub 2021 Nov 17.
The purpose of this study was to determine the risk factors for and prognostic implications of progressive right ventricular systolic dysfunction (RVD) in adults with congenitally corrected transposition of great arteries.
There are no effective therapies for RVD; hence the need to identify and modify risk factors for progressive RVD.
RV systolic function was assessed by using RV longitudinal strain (RV-LS). The first echocardiogram (baseline echocardiogram) and all subsequent annual echocardiograms performed within 5 years from the baseline echocardiogram were analyzed. Progressive RVD (temporal decline in RV-LS) was assessed as the average annual change in RV-LS within 5 years of imaging follow-up.
Of 186 patients (mean age 40 ± 12 years), the RV-LS at baseline was -17% ± 4%, and the annual decline in RV-LS was -4% (95% CI: -6 to -2). The risk factors for progressive RVD were left ventricular (LV) systolic dysfunction, LV pacing, and systemic hypertension. Cardiovascular events (heart failure hospitalization, heart transplant, and death) occurred in 57 (27%) patients. Progressive RVD was associated with cardiovascular events, independent of RV systolic function at baseline. In subgroup analyses assessing impact of therapies (medical therapy, cardiac resynchronization therapy, and tricuspid valve replacement), only tricuspid valve replacement was associated with improvement in RV systolic function when performed before onset of RVD.
Patients with congenitally corrected transposition of great arteries were at risk for progressive RVD, and the risk factors for progressive RVD were LV pacing, systemic hypertension, and concomitant LV dysfunction. Further studies are required to determine whether strict blood pressure control and early tricuspid valve replacement will prevent progressive RVD.
本研究旨在确定成人矫正型大动脉转位患者右心室收缩功能障碍（RVD）进展的危险因素及其预后意义。
目前尚无治疗 RVD 的有效方法；因此，有必要确定并改变 RVD 进展的危险因素。
采用 RV 纵向应变（RV-LS）评估 RV 收缩功能。分析首次超声心动图（基线超声心动图）以及基线超声心动图后 5 年内进行的所有后续年度超声心动图。通过在影像学随访的 5 年内 RV-LS 的平均年度变化来评估 RVD 的进展（RV-LS 的时间下降）。
在 186 例患者（平均年龄 40 ± 12 岁）中，基线 RV-LS 为-17% ± 4%，RV-LS 的年下降率为-4%（95%CI：-6 至-2）。RVD 进展的危险因素包括左心室（LV）收缩功能障碍、LV 起搏和系统性高血压。57 例（27%）患者发生心血管事件（心力衰竭住院、心脏移植和死亡）。在独立于基线 RV 收缩功能的情况下，RV 进展与心血管事件相关。在评估治疗（药物治疗、心脏再同步治疗和三尖瓣置换术）影响的亚组分析中，只有在 RVD 发生之前进行的三尖瓣置换术与 RV 收缩功能的改善相关。
矫正型大动脉转位患者存在 RVD 进展风险，RVD 进展的危险因素包括 LV 起搏、系统性高血压和合并的 LV 功能障碍。需要进一步研究以确定严格的血压控制和早期三尖瓣置换术是否可以预防 RVD 的进展。
