Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey.
Eur Heart J Cardiovasc Imaging. 2023 Apr 24;24(5):635-642. doi: 10.1093/ehjci/jeac136.
In pulmonary arterial hypertension (PAH), the right ventricle (RV) is exposed to an increased afterload. In response, RV mechanics are altered. Markers which would relate RV function and afterload could therefore aid to understand this complex response system and could be of prognostic value. The aim of our study was to (i) assess the RV-arterial coupling using ratio between RV strain and systolic pulmonary artery pressure (sPAP), in patients with PAH, and (ii) investigate the prognostic value of this new parameter over other echocardiographic parameters.
Echocardiograms of 65 pre-capillary PAH patients (45 females, age 61 ± 15 years) were retrospectively analysed. Fractional area change (FAC), sPAP, tricuspid annular plane systolic excursion, and RV free-wall (FW) longitudinal strain (LS) were measured. A primary endpoint of death or heart/lung transplantation described clinical endpoint. Patients who reached a clinical endpoint had worse functional capacity (New York Heart Association), reduced RV function, and higher sPAP. Left ventricle function was similar in both groups. Only RVFW LS/sPAP ratio was found as an independent predictor of clinical endpoint in multivariable analysis (hazard ratio 8.3, 95% confidence interval 3.2-21.6, P < 0.001). The RWFW LS/sPAP (cut-off 0.19) demonstrated a good accuracy for the prediction of reaching the clinical endpoint, with a sensitivity of 92% and specificity of 82.5%.
RVFW LS/sPAP ratio significantly predicts all-cause mortality and heart-lung transplantation, and was superior to other well-established parameters, in patients with pre-capillary PAH. We therefore propose RVFW LS/sPAP as a new prognostic echocardiographic marker.
在肺动脉高压（PAH）中，右心室（RV）承受增加的后负荷。作为响应，RV 力学发生改变。因此，与 RV 功能和后负荷相关的标志物可以帮助理解这个复杂的反应系统，并具有预后价值。本研究的目的是：（i）评估肺动脉高压患者的 RV-动脉耦合，使用 RV 应变与收缩期肺动脉压（sPAP）的比值；（ii）研究这个新参数对其他超声心动图参数的预后价值。
回顾性分析了 65 例毛细血管前 PAH 患者（45 名女性，年龄 61 ± 15 岁）的超声心动图。测量了射血分数（FAC）、sPAP、三尖瓣环平面收缩期位移和 RV 游离壁（FW）纵向应变（LS）。死亡或心肺移植作为主要终点描述了临床终点。达到临床终点的患者的功能能力（纽约心脏协会）更差，RV 功能降低，sPAP 更高。两组左心室功能相似。仅 RVFW LS/sPAP 比值在多变量分析中被发现是临床终点的独立预测因子（危险比 8.3，95%置信区间 3.2-21.6，P < 0.001）。RVFW LS/sPAP（截断值 0.19）在预测达到临床终点方面具有良好的准确性，敏感性为 92%，特异性为 82.5%。
在毛细血管前 PAH 患者中，RVFW LS/sPAP 比值显著预测全因死亡率和心肺移植，优于其他已确立的参数。因此，我们提出 RVFW LS/sPAP 作为一种新的预后超声心动图标志物。
