Sert Sena, Selçuk Nehir, Yıldırımtürk Özlem, Orhan Gökçen
Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye.
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2022 Jul 29;30(3):334-343. doi: 10.5606/tgkdc.dergisi.2022.23218. eCollection 2022 Jul.
In this study, we aimed to investigate the prognostic value of the tricuspid annular plane systolic excursion (TAPSE)/ pulmonary arterial systolic pressure (PASP) ratio in right ventricular failure patients undergoing left ventricular assist device implantation.
Between February 2013 and February 2020, a total of 75 heart failure patients (65 males, 10 females; median age: 54 years; range, 21 to 66 years) were retrospectively analyzed. The prognostic value of TAPSE/PASP ratio was assessed using the multivariate Cox regression models and confirmed using the Kaplan-Meier analyses.
Forty-one (55.4%) patients had an ischemic heart failure etiology. The indication for assist device implantation was bridge to transplant in 64 (85.3%) patients. The overall survival rates at one, three, and five years following left ventricular assist device implantation were 82.7%, 68%, and 49.3%, respectively. Right ventricular failure was observed in 24 (32%) patients during follow-up. In the multivariate analysis, TAPSE/PASP was found to be independently associated with postoperative right ventricular failure (HR: 1.63; 95% CI: 1.49-2.23). A TAPSE/PASP of 0.34 mm/mmHg was found to be the most accurate predictor value, with lower ratios correlating with right ventricular failure. The Kaplan-Meier analysis showed a better overall survival using a TAPSE/PASP ≥ of 0.34 mm/mmHg (p<0.001).
A lower TAPSE/PASP ratio, particularly lower values than 0.34 mm/mmHg, strongly predicts right ventricular failure after left ventricular assist device implantation in patients with advanced heart failure.
在本研究中，我们旨在探讨三尖瓣环平面收缩期位移（TAPSE）/肺动脉收缩压（PASP）比值对接受左心室辅助装置植入的右心室衰竭患者的预后价值。
回顾性分析2013年2月至2020年2月期间的75例心力衰竭患者（65例男性，10例女性；中位年龄：54岁；范围21至66岁）。使用多变量Cox回归模型评估TAPSE/PASP比值的预后价值，并通过Kaplan-Meier分析进行验证。
41例（55.4%）患者病因是缺血性心力衰竭。64例（85.3%）患者植入辅助装置的指征是过渡到移植。左心室辅助装置植入后1年、3年和5年的总生存率分别为82.7%、68%和49.3%。随访期间24例（32%）患者出现右心室衰竭。在多变量分析中，发现TAPSE/PASP与术后右心室衰竭独立相关（风险比：1.63；95%置信区间：1.49 - 2.23）。发现TAPSE/PASP为0.34 mm/mmHg是最准确的预测值，比值越低与右心室衰竭相关。Kaplan-Meier分析显示，TAPSE/PASP≥0.34 mm/mmHg时总体生存率更好（p<0.001）。
较低的TAPSE/PASP比值，尤其是低于0.34 mm/mmHg的值，强烈预示晚期心力衰竭患者左心室辅助装置植入后会出现右心室衰竭。
