Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2023 Aug 8;82(6):489-499. doi: 10.1016/j.jacc.2023.05.010. Epub 2023 May 22.
Limited data exist to characterize novel measures of right ventricular (RV) function and the coupling to pulmonary circulation in patients with heart failure and preserved left ventricular ejection fraction (HFpEF).
This study sought to assess the clinical implications of RV function, the association with N-terminal pro-B-type natriuretic peptide, and the risk for adverse events among patients with HFpEF.
This study analyzed measures of RV function by assessing absolute RV free wall longitudinal strain (RVFWLS) and its ratio to estimated pulmonary artery systolic pressure (PASP) (RVFWLS/PASP ratio) in 528 patients (mean age 74 ± 8 years, 56% female) with adequate echocardiographic images quality enrolled in the PARAGON-HF trial. Associations with baseline N-terminal pro-B-type natriuretic peptide and with total HF hospitalizations and cardiovascular death were assessed, after accounting for confounders.
Overall, 311 patients (58%) had evidence of RV dysfunction, defined as absolute RVFWLS <20%, and among the 388 patients (73%) with normal tricuspid annular planar systolic excursion and RV fractional area change, more than one-half showed impaired RV function. Lower values of RVFWLS and RVFWLS/PASP ratios were significantly associated with higher circulating N-terminal pro-B-type natriuretic peptide. With a median follow-up of 2.8 years, there were 277 total HF hospitalizations and cardiovascular deaths. Both absolute RVFWLS (HR: 1.39; 95% CI: 1.05-1.83; P = 0.018) and RVFWLS/PASP ratio (HR: 1.43; 95% CI: 1.13-1.80; P = 0.002) were significantly associated with the composite outcome. Treatment effect of sacubitril/valsartan was not modified by measures of RV function.
Worsening RV function and its ratio to pulmonary pressure is common and significantly associated with an increased risk of HF hospitalizations and cardiovascular death in patients with HFpEF. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).
目前仅有有限的数据可以描述射血分数保留的心力衰竭（HFpEF）患者右心室（RV）功能和与肺循环耦联的新指标。
本研究旨在评估 HFpEF 患者 RV 功能的临床意义、与 N 末端 B 型利钠肽原（NT-proBNP）的相关性以及不良事件风险。
这项研究分析了 528 名患者（平均年龄 74±8 岁，56%为女性）的 RV 功能指标，这些患者来自 PARAGON-HF 试验，且超声心动图图像质量良好。评估了 RV 游离壁纵向应变绝对值（RVFWLS）及其与估测肺动脉收缩压（PASP）的比值（RVFWLS/PASP 比值）与基线 NT-proBNP 的相关性，以及与 HF 住院和心血管死亡的总事件的相关性，这些相关性在考虑了混杂因素后进行了评估。
总的来说，311 名患者（58%）存在 RV 功能障碍，定义为 RVFWLS<20%，在 388 名（73%）三尖瓣环平面收缩期位移和 RV 节段面积变化正常的患者中，超过一半存在 RV 功能障碍。RVFWLS 和 RVFWLS/PASP 比值较低与循环 NT-proBNP 水平升高显著相关。中位随访 2.8 年后，共发生 277 次 HF 住院和心血管死亡事件。RVFWLS 绝对值（HR：1.39；95%CI：1.05-1.83；P=0.018）和 RVFWLS/PASP 比值（HR：1.43；95%CI：1.13-1.80；P=0.002）与复合终点显著相关。沙库巴曲缬沙坦的治疗效果不受 RV 功能指标的影响。
RV 功能恶化及其与肺压的比值在 HFpEF 患者中很常见，与 HF 住院和心血管死亡风险增加显著相关。（LCZ696 与缬沙坦在射血分数保留的心力衰竭患者中的疗效和安全性比较[PARAGON-HF]；NCT01920711）。
