先天性心脏病相关肺动脉高压患者右心室功能的多参数评估
Multiparametric evaluation of right ventricular function in pulmonary arterial hypertension associated with congenital heart disease.
作者信息
Fournier Emmanuelle, Selegny Maëlle, Amsallem Myriam, Haddad Francois, Cohen Sarah, Valdeolmillos Estibaliz, Le Pavec Jérôme, Humbert Marc, Isorni Marc-Antoine, Azarine Arshid, Sitbon Olivier, Jais Xavier, Savale Laurent, Montani David, Fadel Elie, Zoghbi Joy, Belli Emre, Hascoët Sebastien
机构信息
Division of Congenital Heart Diseases, Expert Center for Complex Congenital Heart Disease (M3C Network), Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Le Plessis Robinson, France.
Division of Congenital Heart Diseases, Expert Center for Complex Congenital Heart Disease (M3C Network), Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Le Plessis Robinson, France; Pediatric and Congenital Cardiology Unit, University Hospital of Amiens, Amiens, France.
出版信息
Rev Esp Cardiol (Engl Ed). 2023 May;76(5):333-343. doi: 10.1016/j.rec.2022.07.010. Epub 2022 Aug 6.
INTRODUCTION AND OBJECTIVES
Outcome in patients with congenital heart diseases and pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Two-dimensional echocardiographic parameters, such as strain imaging or RV end-systolic remodeling index (RVESRI) have emerged to quantify RV function.
METHODS
We prospectively studied 30 patients aged 48±12 years with pretricuspid shunt and PAH and investigated the accuracy of multiple echocardiographic parameters of RV function (tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity, RV systolic-to-diastolic duration ratio, right atrial area, RV fractional area change, RV global longitudinal strain and RVESRI) to RV ejection fraction measured by cardiac magnetic resonance.
RESULTS
RV ejection fraction <45% was observed in 13 patients (43.3%). RV global longitudinal strain (ρ [Spearman's correlation coefficient]=-0.75; P=.001; R=0.58; P=.001), right atrium area (ρ=-0.74; P <.0001; R=0.56; P <.0001), RVESRI (ρ=-0.64; P <.0001; R=0.47; P <.0001), systolic-to-diastolic duration ratio (ρ=-0.62; P=.0004; R=0.47; P <.0001) and RV fractional area change (ρ=0.48; P=.01; R=0.37; P <.0001) were correlated with RV ejection fraction. RV global longitudinal strain, RVESRI and right atrium area predicted RV ejection fraction <45% with the greatest area under curve (0.88; 95%CI, 0.71-1.00; 0.88; 95%CI, 0.76-1.00, and 0.89; 95%CI, 0.77-1.00, respectively). RV global longitudinal strain >-16%, RVESRI ≥ 1.7 and right atrial area ≥ 22 cm predicted RV ejection fraction <45% with a sensitivity and specificity of 87.5% and 85.7%; 76.9% and 88.3%; 92.3% and 82.4%, respectively.
CONCLUSIONS
RVESRI, right atrial area and RV global longitudinal strain are strong markers of RV dysfunction in patients with pretricuspid shunt and PAH.
引言与目的
先天性心脏病合并肺动脉高压（PAH）患者的预后与右心室（RV）功能密切相关。二维超声心动图参数，如应变成像或右心室收缩末期重构指数（RVESRI）已用于量化右心室功能。
方法
我们前瞻性研究了30例年龄48±12岁、存在三尖瓣前分流和PAH的患者，探讨了右心室功能的多个超声心动图参数（三尖瓣环平面收缩期位移、三尖瓣环收缩期峰值速度、右心室收缩期与舒张期持续时间比、右心房面积、右心室面积变化分数、右心室整体纵向应变和RVESRI）与心脏磁共振测量的右心室射血分数的准确性。
结果
13例患者（43.3%）右心室射血分数<45%。右心室整体纵向应变（ρ[斯皮尔曼相关系数]=-0.75；P = 0.001；R = 0.58；P = 0.001）、右心房面积（ρ=-0.74；P < 0.0001；R = 0.56；P < 0.0001）、RVESRI（ρ=-0.64；P < 0.0001；R = 0.47；P < 0.0001）、收缩期与舒张期持续时间比（ρ=-0.62；P = 0.0004；R = 0.47；P < 0.0001）和右心室面积变化分数（ρ = 0.48；P = 0.01；R = 0.37；P < 0.0001）与右心室射血分数相关。右心室整体纵向应变、RVESRI和右心房面积预测右心室射血分数<45%时曲线下面积最大（分别为0.88；95%CI，0.71 - 1.00；0.88；95%CI，0.76 - 1.00和0.89；95%CI，0.77 - 1.00）。右心室整体纵向应变>-16%、RVESRI≥1.7和右心房面积≥22 cm²预测右心室射血分数<45%时的敏感性和特异性分别为87.5%和85.7%；76.9%和88.3%；92.3%和82.4%。
结论
RVESRI、右心房面积和右心室整体纵向应变是三尖瓣前分流和PAH患者右心室功能障碍的强标志物。
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