Santoro Ciro, Buonauro Agostino, Canora Angelo, Rea Gaetano, Canonico Mario Enrico, Esposito Roberta, Sanduzzi Alessandro, Esposito Giovanni, Bocchino Marialuisa
Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy.
Respiratory Medicine Unit at the Monaldi Hospital, AO dei Colli, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
J Clin Med. 2022 Oct 17;11(20):6115. doi: 10.3390/jcm11206115.
Background: The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance that can be non-invasively estimated by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD). Methods: Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF) (M = 37; mean age 67 ± 7 years), were studied with standard and speckle-tracking echocardiography and compared with 30 age-matched healthy volunteers. The mean patient follow-up was 70 ± 4 months. Results: Fibrotic ILD patients had a larger right ventricle (RV) and worse diastolic function because the RV global longitudinal strain (GLS) was significantly lower and the systolic pulmonary artery pressure (sPAP) estimates were higher in comparison with those of controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV GLS/sPAP were significantly reduced in f-ILD patients (p < 0.0001). Patients with an RV GLS/sPAP below the median value had a shorter survival time (61 vs. 74 months, p = 0.01); this parameter was an independent predictor of a worse outcome. Conclusion: Low estimates of RV GLS/sPAP are predictive of worse outcomes in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis implications.
右心室（RV）与肺循环的耦合是右心室功能的一个指标，可通过超声心动图进行无创评估。目前尚无关于其在纤维化间质性肺疾病（f-ILD）患者中应用的数据。方法：对50例f-ILD患者进行研究，其中包括27例特发性肺纤维化（IPF）患者（男性 = 37例；平均年龄67±7岁），采用标准超声心动图和斑点追踪超声心动图进行检查，并与30名年龄匹配的健康志愿者进行比较。患者的平均随访时间为70±4个月。结果：纤维化ILD患者的右心室较大且舒张功能较差，因为与对照组相比，其右心室整体纵向应变（GLS）显著降低，收缩期肺动脉压（sPAP）估计值较高。相反，对照组和患者之间的三尖瓣环收缩期位移（TAPSE）没有差异。f-ILD患者的TAPSE/sPAP和RV GLS/sPAP中位数显著降低（p < 0.0001）。RV GLS/sPAP低于中位数的患者生存时间较短（61个月对74个月，p = 0.01）；该参数是预后较差的独立预测因素。结论：RV GLS/sPAP估计值低可预测f-ILD患者预后较差。右心室耦合似乎是右心室功能的一个有前景的替代生物标志物，可用于区分患者表型，对管理和预后具有重要意义。
