Departments of Cardiovascular Medicine.
Departments of Cardiovascular Medicine.
Am J Cardiol. 2023 Apr 1;192:101-108. doi: 10.1016/j.amjcard.2023.01.025. Epub 2023 Feb 8.
The purpose of this study was to assess the prevalence of right ventricular (RV) systolic dysfunction in adults with anatomic repair of dextro-transposition of great arteries (d-TGAs), and to determine its relation to clinical outcomes across multiple domains (functional status, peak oxygen consumption, N-terminal pro-brain natriuretic peptide, and heart failure hospitalization). Adults with anatomic repair for d-TGA and with echocardiographic images for strain analysis were divided into 2 groups: (1) d-TGA status after an arterial switch operation (d-TGA-ASO group) and (2) d-TGA status after a Rastelli operation (d-TGA-Rastelli group). RV systolic function was assessed using RV global longitudinal strain (RVGLS), and RV systolic dysfunction was defined as RVGLS >-18%. We identified 151 patients (median age 21 years [19 to 28]; d-TGA-ASO group 89 [59%], and d-TGA-Rastelli group 62 [41%]). The mean RVGLS was -22 ± 4%, and 47 patients (31%) had RV systolic dysfunction. The d-TGA-Rastelli group had lower (less negative) RVGLS than that of the d-TGA-ASO group (-19 ± 3% vs -25 ± 3%, p <0.001) and higher prevalence of RV systolic dysfunction (48% vs 19%, p <0.001). RVGLS (absolute value) was associated with peak oxygen consumption (r = 0.58, p <0.001; adjusted R = 0.28), log-N-terminal pro-brain natriuretic peptide (r = -0.41, p = 0.004; adjusted R = 0.21), New York Heart Association class III/IV (odds ratio 2.29, 1.56 to 3.19, p = 0.01), and heart failure hospitalization (hazard ratio 0.93, 0.88 to 0.98, p = 0.009). RV systolic dysfunction was common in adults with d-TGA and anatomic repair and was associated with clinical outcomes. Longitudinal studies are required to determine the risk factors for progressive RV systolic dysfunction and to identify strategies for preventing RV systolic dysfunction in this population.
本研究旨在评估解剖修复右旋位大动脉转位（d-TGA）成人的右心室（RV）收缩功能障碍的患病率，并确定其与多个领域（功能状态、峰值耗氧量、N 末端脑利钠肽前体和心力衰竭住院）的临床结果的关系。接受解剖修复的 d-TGA 成人和接受应变分析的超声心动图图像的患者被分为 2 组：（1）动脉转换术后的 d-TGA 状态（d-TGA-ASO 组）和（2）Rastelli 手术后的 d-TGA 状态（d-TGA-Rastelli 组）。RV 收缩功能使用 RV 整体纵向应变（RVGLS）进行评估，RV 收缩功能障碍定义为 RVGLS >-18%。我们共纳入 151 例患者（中位年龄 21 岁[19 至 28]；d-TGA-ASO 组 89 例[59%]，d-TGA-Rastelli 组 62 例[41%]）。RVGLS 的平均值为-22±4%，47 例（31%）存在 RV 收缩功能障碍。d-TGA-Rastelli 组的 RVGLS 比 d-TGA-ASO 组更低（更负）（-19±3%比-25±3%，p<0.001），且 RV 收缩功能障碍的患病率更高（48%比 19%，p<0.001）。RVGLS（绝对值）与峰值耗氧量（r=0.58，p<0.001；调整 R=0.28）、log-N 末端脑利钠肽前体（r=-0.41，p=0.004；调整 R=0.21）、纽约心脏协会心功能分级 III/IV 级（比值比 2.29，1.56 至 3.19，p=0.01）和心力衰竭住院（风险比 0.93，0.88 至 0.98，p=0.009）相关。解剖修复的 d-TGA 成人中 RV 收缩功能障碍较为常见，且与临床结果相关。需要进行纵向研究以确定 RV 收缩功能障碍进行性进展的危险因素，并确定预防该人群 RV 收缩功能障碍的策略。
